One Thing Leads To Another
by Marianna Morgan
Summary: Pre-Series, Teenchesters – It was just routine surgery. But this was Sam. Nothing was routine. - Sick!Hurt!Hospitalized!Sam, Worried!Awesome!BigBrother!Dean – John, Bobby, and Pastor Jim also included
1. Chapter 1

**Summary**: It was just routine surgery. But this was Sam. Nothing was routine. Sick!Hurt!Hospitalized!Sam, Worried!Awesome!BigBrother!Dean - John, Bobby, and Pastor Jim also included

**Disclaimer**: Not mine.

**Warnings**: Just the usual heads-up for language

**Author's Note**: Dedicated to KKBELVIS for several reasons, but the three most important: 1) for being so freakin' awesome; 2) for listening to me ramble on and on and ON about this story; and 3) for inspiring it with this line from her "A Spot To Remember" story: "And what about the tiny white spots decorating the back of Sam's throat, that time the kid got tonsillitis and had to have them removed." In my review of that oneshot, I asked her to write a story to further elaborate on that part, but she threw the ball back in my court...and here we are.

**Before we get started**: This takes place April 1997; Dean's 18, Sam's 13-going-on-14. I realize that cell phones weren't as advanced or as prevalent then as they are today. But the clamshell/flip model that we're so familiar with was available in '97, so I included it because much like my generation, this story would find it hard to exist without a cell phone. Also, while the medical portions have been researched, I'm not a doctor, and this is still fiction, right? Right! So, enough setup. On with the story...

* * *

Nothing is as simple as we hope it will be. ~ Jim Horning

**

* * *

**

One Thing Leads To Another

Dr. Can't-Pronounce-Your-Name sat on a wheeled stool, as he propped a clipboard in the crook of his elbow. "Let me get this straight..." he began, staring over the top of his glasses at his young patient. "You've been diagnosed with strep throat four times over the past year, and this is the first time anyone's mentioned a tonsillectomy?"

The paper sheet that covered the cold metal of the exam table crinkled as Sam shifted, his feet swinging nervously. "Um..."

Dean stepped closer to his little brother, his hand settling on Sam's back – _calm down_ – as he bristled at the tone, irritated by this doctor's sarcastic doubt and all the other doctors' implied incompetence. "They usually just give him antibiotics."

"Well, he needs surgery."

Dean wasn't surprised – he thought the same thing this morning when he shined his flashlight into Sam's mouth, hence this visit – but he felt Sam flinch at the words.

Dean gently squeezed the nape of his little brother's neck. "When?"

"As soon as possible. Any more edema in his throat, and we'll be discussing a breathing tube instead of surgery."

Sam turned wide, horrified eyes to Dean, and Dean felt like punching a doctor.

Dr. Can't-Pronounce-Your-Name just became Dr. Dickhead.

Dean narrowed his eyes. "Don't you need to run tests to confirm it's strep before you go cutting into people?"

"No," Dr. Dickhead replied abruptly. "Swollen lymph nodes in the neck, inflamed tonsils with the characteristic white patches, fever, difficulty swallowing…" He trailed off and shrugged. "It's definitely strep throat, and he definitely needs surgery."

"How about today?" Dean asked, wondering if Sam's eyes could possibly get any wider.

Dr. Dickhead made a dismissive sound. "Not likely. The patient must be off ibuprofen at least three days before surgery, plus refrain from eating or drinking after midnight the day of the procedure as well as – "

"Sam hasn't eaten anything since yesterday's lunch," Dean paused and looked meaningfully at Sam – _yeah, I noticed_ – "and we ran out of ibuprofen four days ago..." – _which I'm still pissed about, but I guess it's working to our advantage now_ – "So, he's good to go. Let's do this."

Sam's breath hitched. "Dean..."

Dean responded by lightly patting Sam's back. _It's okay._

Dr. Dickhead looked skeptical. "Are you serious?"

"Hell yeah. Seize the day, right Sammy?"

Sam said nothing at Dean's nudge, as the doctor's gaze flickered between the brothers.

"I'd have to check with United Hospital over in Blue Earth, see if there's anything available this afternoon."

"Blue Earth," Sam echoed, his voice a whisper as he glanced at Dean.

"Yes, since Wells Clinic is part of the United Hospital District, we usually send our referrals over there."

Dean nodded. "Sounds good."

"I should warn you that they don't like their patients to travel out of reach of their facility for at least 14 days after surgery, in case of complications. You'll want to keep that in mind when arranging where you'll stay after Sam's released, since you said earlier that you were just passing through Wells."

Dean nodded again, making a mental note to call Pastor Jim and to research "tonsillectomy complications," just as Sam leaned into him, the kid's body a rod of rigidity and yet his legs were still swinging.

Dean smiled softly and reacted to his little brother's tension by rubbing his thumb at the base of Sam's skull. _Seriously. Relax. It's okay._

"How soon will you know if they can fit Sam in?"

"Let's see..." Dr. Dickhead sighed and checked his watch. "It's almost lunchtime, which means it'll be hard to get in touch with anyone for at least an hour, then figure in time for calls and pages to be returned…" He shrugged. "I'd say we'll know something by 3:00 this afternoon, which should be plenty of time since the actual surgery doesn't usually take more than 30 minutes."

Dean felt Sam marginally relax as he looked up, hopeful yet skeptical, his voice quiet. "That's all?"

"That's all," Dr. Dickhead confirmed, and the way he almost smiled at Sam made Dean think that he might have to change this man's name again to something a little less harsh. "But you'll still have to go through recovery, and then you'll be moved to a short-stay post-op room just to make sure everything's okay. If no problems present, then you'll be allowed to leave, but it will take at least a week or two, if not three, for you to be completely recovered and back on your feet to resume normal activities."

Dean snorted as Sam sighed, his thoughts mirroring his brother's: _Dad's gonna love that._

"But we're running ahead of ourselves." The doctor stood. "Let's concentrate on getting the surgery scheduled, and in the meantime, you two can wait out in the lobby. If you need to leave, make sure you give your number to the nurse so we can contact you." He glanced at Sam on his way out. "And sorry to say it, but no lunch for you or anything to drink until we know what the afternoon holds."

Sam nodded that he understood and waited for the door to click shut before sliding off the table and looking up at Dean. "I have a bad feeling about this."

Dean rolled his eyes. "Dramatic much?"

Sam's expression immediately darkened.

"Hey. Don't bitchface me."

"'Bitchface' isn't a verb."

"It is with you," Dean snapped and turned toward the door. "Stop being such a girl and move your ass. We've got calls of our own to make."

Sam didn't budge, his scowl melting into his other not-so-secret weapon, as his large eyes welled with tears and blinked under the fringe of his bangs.

"Dude," Dean said, his tone both irritated and gentle. "What's with you?"

Sam shook his head and looked away, embarrassed. Dean was right; he _was_ a girl.

"Sammy..."

Sam shook his head harder, closing his eyes to stop the tears but feeling them slip from the corners instead. _Traitorous bastards_.

Dean stared at his brother, taking in Sam's flushed face and slumped posture and slowly nodded, realizing the problem and feeling like an ass for not recognizing it sooner.

Sam had felt like crap for at least a week; he had been the source of an argument with their dad in a motel parking lot just a few hours ago; and now they were talking about surgery. Dean knew from 13 years of experience that his little brother was crying from being sick and exhausted and worried and scared and too damned overwhelmed to take anymore.

Dean gently grasped Sam's shoulders, pulling the younger boy toward him. Sam didn't resist, his head pressed to the center of his big brother's chest, his cheek beside the amulet that hung from Dean's neck. Dean's right hand rested on the back of Sam's head as his left hand splayed between his shoulders, rubbing back and forth.

"You know it's going to be okay, right? We'll take care of this, go to Pastor Jim's for a few days. Everything's gonna be fine."

Sam's only response was a strangled sob as his arms circled Dean's waist.

Dean instinctively tightened his grip. "Hey. Relax, kiddo. I'm here, and you know I'm not gonna let anything bad happen to you."

Sam nodded against Dean's chest, silent tears streaking his cheeks as he leaned into the solid presence of his brother, comforted by the fact that although he may endure teasing later, Dean would stand there as long it took for him to pull himself together.

A knock on the door startled both brothers before one of the nurses entered. "We're going to need this room."

Sam sniffled and turned his head sideways to look at her, still resting against Dean. The fact that he hadn't immediately separated from his brother upon a stranger's arrival was testament to just how crappy he felt, and Dean felt his protective streak flare.

Dean gave her a cursory glance before turning back to Sam. "Give us a minute."

"We have other patients and – "

Dean glared over his shoulder, effectively repeating himself and shutting her up.

The nurse nodded, backing into the hall and closing the door.

"What's with all the staff around here? All bitches and dickheads, I swear..." Dean groused, encouraged when he felt Sam take a shuddering breath and huff a shaky laugh. He carded his fingers through the hair at the base of Sam's skull. "You good?"

Sam pushed back, his face flushed from fever, fatigue, and tears. "Yeah," he responded, emotion making his voice hoarser than it was before, sounding like he had gargled rocks. He smiled shyly, wiping his eyes with the back of his hand. "Thanks."

Dean returned the smile, holding his brother's gaze – _anytime, Sammy_ – before breaking into his best announcer's voice. "And the Academy Award for Best Dramatic Performance goes to..."

Sam answered his brother with one finger even as he grinned, dimples and all.

Dean laughed, looping an arm around Sam's neck. "C'mon, Sammy," he said, steering his little brother toward the door. "Everything's gonna be fine."

* * *

"Dad, it's us," Dean said, squinting in the early afternoon sun as he stood outside United Hospital, holding out his cell phone between himself and Sam. "They say it's strep throat again, and Sam's tonsils need to come out. In fact, we're in Blue Earth right now, about to head into the hospital. Sam's scheduled for surgery in a few hours."

Sam wrinkled his nose and shifted from where he stood facing his brother. The more he heard that idea, the less he liked it.

There was silence, and Dean checked to make sure the speaker function was turned on.

"Dad?"

"Yeah," John replied.

Dean exchanged glances with Sam. They knew that tone.

"Well?"

"Well," John echoed, sounding annoyed and then dismissive. "Handle it, Dean. It's just routine surgery."

Sam gulped, his eyes wide as he stared at Dean. As predicted, this news did not put John in his happy place.

Dean shook his head slightly and was surprised by the irritation that flared at his father's flippant tone. This was Sam. Nothing was routine. "I know, but don't you think you should still – "

"Dean, I don't have time for this," John interrupted.

"But Dad – "

"Take me off speaker."

There was a moment's hesitation, but Dean did as he was told – as John knew he would – and Sam watched as his older brother's jaw tightened and twitched from restrained frustration and anger over the orders he was receiving. Even the customary "yes sirs" that punctuated any conversation Dean had with John were absent, and Sam didn't even know the phone call was over until he realized his brother was just standing there, staring at the phone.

Sam's gaze flickered to the sidewalk, uncomfortable with the awkward silence, especially since he knew what it meant. Sam knew from personal experience that no returned parting words – no "bye, Dad...see you later...talk to you soon" – meant John hadn't offered any, either; he had just given orders, expected them to be followed without question, and hung up.

Dean slowly pocketed his phone before rearranging his expression. "Well," he said, forcing a smile. "Looks like it's just me and you, kiddo."

_Always is,_ Sam thought as he nodded in response, and although he'd never admit it to Dean, he preferred it that way.

Sam loved his dad, but he hadn't liked him in years. Dean was the only constant in his life, the only person he loved unconditionally and trusted without question. As long as he had his brother, the rest of the world could kiss Sam's ass...including John Winchester.

"It's okay," Sam rasped, glancing up through his bangs, trying to soothe Dean more than himself.

Dean's gaze drifted to the traffic in the street beyond, his jaw still bunched and tight with suppressed emotion.

He was frustrated.

He was pissed.

And if he was honest with himself, he was disappointed.

Even though experience had taught him otherwise, Dean always thought that _this_ time would be different; _this_ time their dad would come through; _this_ time their dad would put them ahead of a hunt. Only every "this time" turned out like last time...and Dean was sick of it. Sam deserved better.

"You deserve better, too."

Dean smirked, looking back at his little brother, equally touched and amused – but not surprised – that Sam knew him so well as to know what he was thinking.

Sam smiled shyly and then shivered as a brisk wind swept through the covered breezeway of the hospital. It was April, and the sun was shining, but it was still _cold _in Minnesota.

"Come on," Dean said, draping his arm over Sam's slender shoulders and steering him toward the double automatic doors. "Sick people should be inside."

"Not according to Dad."

"Well, Dad's an ass," Dean stated bluntly, remembering all too well the confrontation earlier that morning in the motel parking lot about how fresh air and exertion were good for the body, how it was all about "mind over matter," how Sam should push through.

Normally, Dean might have been inclined to agree – he had hunted with a sore throat many times – but one look in Sam's mouth had changed his mind.

White splotches, almost like a film, coated the back of Sam's throat, and if his tonsils swelled any more, they probably would obstruct the kid's breathing. Not to mention the fever and general listlessness.

In typical Winchester fashion, Sam had said nothing about being sick, but Dean could write a book on the stages of sick Sammy, and he knew the signs: less talking, more sleeping, and no eating meant a sick little brother.

Dean had stood his ground, adamant that Sam needed a doctor, as John had stood in stony silence and Sam had stared at the pavement. Dean didn't know how much time had passed before John had opened the door of his truck and climbed in.

"Call me later," he had said before driving away.

Dean snorted. _A lot of good that did._

"Do you think Pastor Jim got our message?"

Dean glanced over at Sam as they entered the hospital lobby. "I'm sure he did."

"What if he didn't? He didn't call back."

"I didn't ask him to."

"But what if he doesn't know we're coming and we just show up?"

Dean shrugged, effectively ending the topic. It wouldn't be the first time the Winchesters showed up on Jim Murphy's doorstep unannounced.

"So..." Sam sighed and then coughed when the rush of air irritated his throat. "What now?"

"First of all, you stop talking. You sound like shit."

Sam glared, the expression dulled by the fevered weakness in his eyes.

"And second of all," Dean continued as they approached the nurses' desk, "we get this show on the road."

"Hi. May I help you?"

Dean smiled at the woman behind the desk – "Helen," according to her nametag – and wondered idly if her head hurt from the tightness with which her graying hair was pulled back in that bun.

"My brother's scheduled for surgery."

"Let's see..." Helen said, adjusting her glasses as she grabbed a clipboard and looked at Sam. "What's your name, sweetie?"

"Sam." He cleared his throat and then winced. "Sam Cooper."

Helen frowned at the sound of his voice. "Goodness. Guess you're my tonsillectomy patient, huh?" She smiled as Sam nodded. "Well, this will be no sweat; you'll be in, out, and home before you know it." She looked at Dean, pushing another clipboard into his hands from across the counter. "The clinic sent over the paperwork you completed earlier, so we have Sam's medical history and most of all the other information we need, but there's a couple of sections we need to go over." She flipped to page three and pointed. "Here...you forgot to fill out the insurance portion, and we're definitely going to need that."

"Sure," Dean replied casually even as his stomach dropped.

While the clinic had overlooked the omission, he should have known that wouldn't be the case at the hospital – especially when they were here for surgery – which sucked because the information was omitted for a reason.

Insurance for them was a complete sham, but at least they usually had a card to make it look official until it was too late or they were too far gone for it to matter. But their latest insurance cards had met untimely deaths in last month's laundry – _thank you, hot blonde chick in the Laundromat for proving that temptation does lead to distraction_ – and although John had been pissed, replacing them hadn't been at the top of his list.

Dean noticed Sam's worried gaze and shrugged slightly. He was good at making up shit. He'd think of something.

"Also," Helen continued, flipping to page six, "since your brother's a minor, we need the signature of a parent or legal guardian giving consent for the surgery...but you signed."

Dean cut his eyes at the nurse, fighting to keep annoyance out of his voice. "Yeah...so?"

"Well, unless you're primarily responsible for Sam's care, your signature is not going to be sufficient."

Dean's eyes narrowed, his voice unnervingly calm. "Sam _is_ my responsibility."

"Well, I'm sure he is when your parents aren't around, but where's your mother?"

"Dead," Dean spat, hearing Sam's quick intake of air and thinking he would be completely justified in slapping this woman.

"Oh." Helen blanched. "I'm...I'm sorry. Your father?"

"Not here."

"Is he alive?" Helen asked tentatively.

"Last time I checked," Dean responded, amused when the nurse's expression indicated that she thought he was being a smartass. If only she knew their line of work.

"Then we'll call him."

"He's out of town and unavailable."

Helen paused, sizing him up. "Do you have any other relatives?"

Dean sighed loudly. "No."

"Then who's responsible for your brother?"

"I. Am."

"Well, yes of course, but – "

"Listen, lady – I'm 18 and an adult, and in the absence of a parent, an adult sibling can give consent for medical care of a minor."

Translation: _Fuck off, bitch._

Sam shifted nervously in the silence that followed, hoping the nurse was smart enough to let it drop. Few things pissed Dean off any faster than having his care of Sam called into question. Sam knew that among all the words his older brother would use to describe him, "mine" would be at the top of Dean's list. Sometimes that possessive, overprotective nature annoyed Sam. But other times...most of the time...it made Sam feel safe and loved – and watching others squirm when faced with Dean's wrath was pretty cool, too.

"Point taken," Helen said finally, withdrawing her hand from the clipboard Dean still grasped. "I apologize."

Dean nodded tightly, his jaw clenched in an effort to rein in his words and his temper. He glanced at Sam and softened when he saw how exhausted his brother looked.

"You okay?" he asked quietly.

Sam nodded, but Dean noticed that his little brother's bangs were sticking to his forehead now, and he swallowed with more effort than before

"Look," Dean said, turning back to the nurse. "It's kinda been a long day, and I'm kinda tired of seeing my brother in pain, so if you're done playing 20 questions..."

Dean trailed off, his focus going to Sam.

"Yes, absolutely," Helen responded, tracking Dean's gaze and understanding the message. She rounded the desk and stood beside Sam, eager to make amends. "Ready, sweetie?"

Sam looked alarmed and stepped closer to Dean, bony shoulder brushing muscular arm.

Dean smiled affectionately, lightly patting Sam's back and hoping his little brother would always seek him as a sanctuary. "We're ready." He nodded at Helen. "Lead the way."

**_TBC ~ will hopefully post on Mondays, Wednesdays, and Fridays_**


	2. Chapter 2

Dean sat on the edge of the maroon cushioned chair, elbows resting on bouncing legs as his hands hung between his knees. He hated the way he felt when he was separated from Sam, when Sam was out of his sight. Anxious and panicky, vitals speeding up as time slowed down.

Dean glanced at the clock on the far wall, thinking the damn thing must have stopped because no _way_ had only one minute passed since the last time he checked. He sighed loudly, knowing he should get a grip – Sam was probably fine – but was unable to do so because his little brother had been in surgery for over an hour.

"This should only take about 20 or 30 minutes," had been the surgeon's parting words, and if that was true, then what the fuck was taking so long?

Dean stood abruptly, turning toward the nurses' desk, deciding he would ask just that when Helen suddenly appeared beside him. He instinctively assumed a defensive stance, prepared to eliminate the threat, and then blinked in realization.

"Jesus, lady."

"I'm sorry," Helen replied, completely clueless that in any other circumstance she would be apologizing from the floor. "I didn't mean to startle you, but we have a situation."

Dean felt his heart stutter to a stop – a million possible "situations" flashing through his mind – before it resumed beating on one word, the only thing that mattered: _Sam._

"Is Sam okay?"

Helen nodded. "He is now."

Dean's eyes narrowed, not liking the implication that Sam hadn't been okay prior to this conversation. "_Now?_ What the hell does that mean? Where is he?"

"In recovery."

"I wanna see him."

"I know, but first we need to talk."

Dean shook his head. "Talk while you walk, lady." He moved past her, heading in the direction from which she had come just moments before. "Let's go."

Helen stared at him, knowing from their earlier encounter that he was the type who would cause a scene and then find Sam himself if she didn't oblige.

"Fine," she sighed as she furtively glanced at the nurses' desk. "Follow me."

Dean watched as Helen slid her keycard and then pushed through the "Restricted Area" door.

"Tell me about Sam," he said as he did as she had instructed, following behind and then matching her steps.

"His tonsils ruptured unilaterally."

"What?" Dean hissed.

"Don't worry. It's quite common and sounds worse than it is," Helen soothed. "He was being monitored and was never in any danger. The hemorrhaging was brought under control, the tonsils were removed, and everything was cauterized. He's fine."

Dean could hardly hear her over his own erratic heartbeat. Maybe it did sound worse than it actually was but still..._s__hit._

"Sam's doctor would normally be telling you all of this, but he had to go into an emergency surgery right after he finished with your brother." Helen stopped outside a door at the end of the hall. "He'll be available to talk later, but I figured you and Sam would be long gone by then."

Dean stared at the door, knowing Sam was behind it, but something in the nurse's voice made him pause. "Why?"

"Because I ran your insurance information through the system."

Although her tone was neutral, Dean felt adrenaline buzz through his veins as he realized the implications of that statement.

She knew.

_Fan…damn…tastic._

Experience had taught him that it was better to offer no excuse than a bad one, so Dean simply nodded and waited for her next move.

"It's hospital policy to verify insurance coverage, especially if a patient is undergoing surgery," Helen explained. "I must admit I was a little suspicious of you and your brother, so I ran the information myself before sending it to billing."

Dean exhaled slowly, uncertain what this woman wanted from him but determined to keep it together.

"So now what?"

Helen glanced at another nurse as she walked by, waiting for her to round the corner before turning back to Dean.

"I don't know your situation, but I know you deliberately gave me false information. You don't have the money to pay for all the medical costs incurred today. The hospital doesn't write off as many cases as it used to, thanks to decreased funding, and even if it did, administration doesn't favor those who attempt medical insurance fraud."

Dean's mouth was dry, his breathing harsh.

_Shitshitshit._

As if reading his thoughts, Helen's expression softened. "I also know that you love your brother, and you're doing the best you can for him."

Dean blinked at the sudden sting of tears, momentarily overwhelmed by the situation and the truth of her words. If only she knew how right she was...on _both_ accounts.

"So now what?" Dean repeated, resisting the urge to bust through the door to his left, scoop Sam from the bed, and run like hell. He needed a plan, and the first step in devising an exit strategy was to know her demands.

Helen sighed, staring at the boy in front of her. He may have told her earlier that he was an adult, that he was responsible for his brother – and she didn't doubt either assertion – but the load he carried was still too heavy for his age.

"Sam hasn't awoken from the anesthesia yet, but I've dressed him and removed all IV lines and monitoring equipment," she informed, ignoring his question and crossing to the cart against the wall before removing a brown paper bag from the bottom drawer and pushing it into Dean's hand.

"What's this?"

"Some samples of the pain meds and antibiotics prescribed, along with post-op instructions. It may be another hour or so before Sam wakes, and when he does, he might be nauseous, so keep that in mind. It's likely he'll have a low-grade fever, too, and will probably keep one for the next few days, so don't be alarmed." Helen paused, as if making sure Dean understood the information. "Also, dehydration and post-op bleeding are two of the primary concerns following tonsillectomies, and there's a possibility for ear pain as well. Everything should be fine, but just keep an eye on him."

_I always do,_ Dean thought as he stared at her, his mind catching up with her actions and words.

Apparently he didn't need to devise a plan because Helen already had one, and it matched his perfectly: get Sam and get the hell out.

The paper bag crinkled in Dean's hand as he tightened his grip along the folded top edge. "What's the catch?"

Helen laughed quietly. "No catch. Just consider this an apology for the way I questioned you before."

Dean nodded as Helen glanced around.

"Jean and Shonda just went to get another patient from the OR, so I'm the only nurse on this hall right now. Sam's in there," she said, indicating the door with her chin. "And the exit – "

" – is there," Dean finished, looking over her shoulder.

"Is there," she echoed, holding his gaze when it shifted back to her.

"And the camera pointed at it?"

Helen shrugged. "Worthless."

Dean arched an eyebrow.

"It hasn't worked since a power outage about three weeks ago."

Dean stared at her, his hand tightening on the doorknob. "Thank you."

Helen patted Dean's arm as he brushed by her, entering Sam's room.

"Nurses put their patients above the hospital's bottom line." She shrugged. "I'm just doing my job, hon."

Dean stared at Sam for a moment then glanced over his shoulder as the door began to shut. "Me, too."

Helen smiled, feeling her heart simultaneously swell and crack from the sweet sadness of truth in those two words.

"I know," she whispered, allowing the door to close as she headed back down the hall.

* * *

Dean's right foot was on the gas pedal, his left planted against the floor mat as his cell phone balanced on his left knee, the number dialed, the speaker function turned on. His left hand was on the steering wheel, knuckles white and sore from their tight grip, as his right arm curled around Sam, his right hand splayed protectively across his little brother's chest.

As the phone rang, Dean glanced down at the head resting on his denim-clad thigh, hoping Sam wouldn't rouse until they were safe and settled at Jim Murphy's.

It had been close to 6:00 by the time he had successfully navigated his way out of the hospital; no one seeming to notice or care that Dean was carrying Sam like a baby in a blanket, most observers probably just assuming he was a sick child who was sleeping, judging by some of the maternal smiles he had received – and they hadn't been far off the mark.

Dean had gently loaded Sam into the front seat – putting to use years of practice of holding a sleeping little brother and unlocking a door – before sliding into the driver's side and peeling out onto the highway.

"Hello?"

Dean startled at the sound of the familiar voice filling the Impala, having forgotten he dialed the number just seconds before.

"Jim, it's me."

"Dean." Jim sounded relieved and then anxious. "How's Sam?"

Dean glanced down again, noting the slightly flushed face. He remembered Helen saying it was likely Sam would have a low-grade fever, and it seemed as though it had arrived.

_Great._

"He's fine."

"You took a little too long to answer, Dean."

Dean smiled; Jim knew him too well. "He's a little warm."

"And?"

"That's it. He hasn't come around from the anesthesia yet, so he's truly fine right now. But I know what's coming..."

The nausea that Helen warned about? Oh yeah. That was guaranteed with Sam.

"Wait," Jim said, sounding confused and a bit annoyed. "They didn't keep him in recovery and post-op observation until he regained consciousness?"

"Nope." Dean allowed the Impala's rumble to fill the silence before adding, "Long story."

"I see."

Dean smiled again, taking comfort in knowing that Jim knew from his experience with the Winchesters what had happened – the reason for their hasty retreat from the hospital – and wouldn't badger him for further explanation later.

"So, you're on your way?" Jim asked.

"Yeah, should be there in about 30 minutes or so."

"Sounds good." The slamming of cabinet doors muffled Jim's voice. "I just returned from the store. I wasn't sure what Sam would feel like eating or drinking, so I got a little of everything."

"Did you get the apple juice?"

"Yes, I remembered, and I also have – "

"Doesn't matter," Dean interrupted. "As long you have apple juice, we're good to go."

Jim laughed just as Sam began to stir under Dean's hand.

"Jim, I hate to cut this short..." Dean glanced down. "...but Sam's starting to move around and – "

"Say no more," Jim assured. "I'll finish putting this stuff away, make sure you boys' room is ready, and see you when you get here. Drive safely."

"Will do. Thanks, Jim," Dean said, letting go of the steering wheel long enough to end the call and slip his phone into the pocket of his leather jacket. He needed to call John, but that would have to wait until later.

Dean had just grasped the wheel again when he heard a slurred, hoarse version of his name followed by a whimper. He grimaced – Sam sounded even worse than before – and gently rubbed his brother's chest.

"S'okay, Sammy," he soothed. "Go back to sleep."

"Don't wanna," Sam whined, his eyes still closed.

"Too bad. Back to sleep."

"Why?"

Dean chuckled. Sam was barely conscious, and he wanted to argue?

"Because."

"Hmm..."

"Sam?"

"M'kay..." Sam sighed, rubbing his face on Dean's thigh before settling, his fingers grasping the leg of his brother's jeans.

Dean smiled – damn, he loved this kid – and continued to rub Sam's chest in slow, even motions as his touch and the Impala's engine lulled his little brother back to sleep.

_**TBC ~ Thanks to everyone for the reviews and alerts! **_


	3. Chapter 3

Jim saw the headlights cutting through the darkness and heard the rumble of engine and crunch of gravel under tires before he saw the familiar black muscle car crest the hill leading to his house.

It had started raining ten minutes ago, causing Jim to stand by the door on the porch, waiting for the boys' arrival and holding the largest umbrella he could find in the hall closet.

Jim had just stepped under the umbrella and into the downpour when Dean got out from the driver's side, ran around the front of the car, and opened the passenger's side door.

Ducking in and pulling the hood of Sam's sweatshirt over the kid's head, Dean then backed out with his arms full of blanketed Sammy, thankful Jim was there, covering them from the icy rain as he carried his little brother up the steps and into the foyer.

They had just cleared the doorway when Jim snagged the keys from Dean's fingers and turned around, heading back outside.

"I'll get your bags."

Dean nodded as he carried Sam up the stairs, guided by the soft glow of lamps as he turned left into the hallway, and then left again as he entered the room they typically shared. The house had more than enough rooms for them to have their own, but that just felt...weird.

Although Sam looked scrawny, he was solid muscle and getting taller by the day, and Dean's arms were beginning to shake from exertion as he neared the double bed in the farthest corner. Dean eased his little brother down on the mattress and then took off his leather jacket, shaking it a little as he removed his cell phone from the pocket and placed it on the nightstand. He heard the front door slam downstairs, followed by the flapping of an umbrella, and then footsteps on the stairs as he tossed his jacket on his bed.

"D'n..." Sam mumbled, his eyes at half-mast.

Dean tugged the hood from Sam's head. "Yeah, Sam?"

Sam swallowed and then winced. "Don't feel good."

"I know, kiddo," Dean replied and began disentangling the blanket from his brother. "Let's get you settled, then we'll get you some drugs, okay?"

Sam nodded, his eyes scanning the room. "Dean..."

"Hmm?"

"Where..." Sam blinked up at him. "Where are we?"

Dean tossed the blanket to the foot of the bed before easing off Sam's sneakers and socks. "At Pastor Jim's, remember?"

Before Sam could answer, Jim appeared in the doorway carrying two slightly damp duffle bags.

"Everything okay?" he asked, depositing the bags in the chair by the door.

"I think we're good – " Dean began, only to be interrupted by Sam making a strangled sound and bolting straight up. " – or not," he amended, knowing that look on his brother's face.

Jim shook his head, recognizing the expression as well. He snatched the trashcan from the corner and handed it to Dean before giving the brothers their privacy.

"I'll be downstairs if you need me."

Dean nodded tightly, hearing the door close as he sat next to Sam. Wrapping an arm around his shoulders, Dean tried to lend his weakened little brother support as the first bout of nausea hit.

Sam gagged, his eyes watering.

Dean tightened his grip. Sam hadn't eaten anything in over 24 hours; there was nothing to throw up.

Sam's body tried again, causing him to slump into Dean's lap as his back arched against the forced strain of emptying an empty stomach. Thick saliva, slimy and discolored from bile, hung in syrupy strands from Sam's mouth, hovering over the trashcan, actually swaying in Sam's ragged breaths.

Sam spat, trying to rid his mouth of the bitter taste and milky texture before it triggered another gag response but was too late and heaved again, causing more bile and saliva to coat his chin and dribble on the sheets.

Without hesitation, Dean wiped his wrist across his brother's mouth and then rubbed the mess on his own jeans. Sam's fingers dug painfully into his older brother's legs as he took shallow breaths through his mouth. Dean could feel his little brother's stomach muscles clench and tremble from the strain as Sam braced against him, could feel the kid's ribs barely expanding against his thighs, heard him swallow convulsively.

"Deep breaths, Sammy. Stop fighting it."

Sam shook his head erratically as his eyes squeezed shut. Tears streaked his cheeks as he swallowed against the distinctively sour stench of sickness wafting up from the trashcan.

If he hadn't felt so miserable, he would have been mortified.

Sam opened his mouth to speak but gagged instead, choking and coughing as dense saliva once again clogged his throat.

A few moments passed before Sam moaned low, sounding more like a sob, and rested his cheek on Dean's lap, his face turned toward his big brother, his eyes still closed.

Dean thumbed tears away from Sam's temple as they slipped through his eyelashes. _It's okay, Sammy._ He rubbed his brother's back. _I'm here. You're okay._

Sam let out a shaky breath, his fingers still gripping the fabric of Dean's jeans.

Dean listened to the rain peck at the window and continued to move his hand back and forth between Sam's shoulder blades, feeling the tension ease out of his brother's muscles with each pass from left to right.

"Better?"

Sam nodded weakly.

Dean placed the trashcan on the floor, glancing over the rim to make sure there was no blood mixed in the mess, and sighed when he saw none, pushing the bin further away with his boot. Dean then looped his hand in the hem of his own shirt and wiped Sam's mouth and chin, smiling when his little brother squirmed, reminding him of toddler Sammy resisting having his face cleaned.

"Deeeeean..." Sam complained, sounding as sick and exhausted as he was.

Dean didn't flinch, continuing his task. "Stop, Sam."

"S'gross."

"Trust me," Dean snorted affectionately, unwinding his hand from the corner of his shirt. "I've done grosser things for you."

Sam's nose wrinkled as he rolled off Dean and onto his back, shifting uncomfortably on the mattress.

"Hot."

"Bet so," Dean agreed, brushing sweaty, straggly bangs off Sam's forehead before placing his cool palm against the fevered skin. "Let's get this hoodie off, huh? Gotta be roasting in that thing. All those layers you wear."

"'Kay," Sam replied, continuing to lie on the bed but raising his arms.

Dean smiled, reminded of the times he had dressed and undressed a much younger Sammy and was both amused and touched that, judging by his little brother's actions, Sam remembered, too.

In the next instant, Sam's sweatshirt was off, flung to land beside Dean's leather jacket on the other bed.

Dean rested his hand on Sam's chest, palm feeling the damp t-shirt, fingers brushing clammy skin along the neckline. He glanced at the bags resting in the chair by the door.

"Sam? Think you can handle a shower?"

Sam opened his eyes and shrugged. _Maybe._

"Good. Let's sit you up," Dean responded, his calloused hand cupping the back of Sam's neck. "Ready? On three..."

"Promise?"

Dean smirked. "Yep. Tonight 'three' means three, not two. Promise."

"'Kay."

"Here we go," Dean warned.

Sam closed his eyes, listening to his brother slowly count. On "three", he was distantly aware of being pulled upright, and he gagged before he could stop himself, his eyes snapping open just in time to see red-tinged saliva drool from his lax mouth onto Dean's shirt.

Panic – from the sight of blood and the realization that he just threw up on his brother – surged through Sam's system, causing him to heave again, spewing more watery vomit on Dean and himself.

"Ugh...D'n..." Sam gasped, his fingers slick with sweat and sickness, tangled in his brother's shirt. "S'ry." He coughed. "D'n...s'ry."

"Hush, Sam," Dean gently admonished, drawing his little brother's head to rest on his shoulder. "It's okay."

"S'ry," Sam repeated, now more upset by the embarrassment than the thin red smudges he could feel on his lips, could see on the fabric of his brother's shirt.

"Don't worry about it, Sammy," Dean soothed. "Just try to relax for me. I gotcha, just relax."

"Blood."

"I know," Dean replied evenly, thumbing the blood from Sam's bottom lip. "It's okay. Your throat's just irritated from all this throwing up. As long as you don't bleed any more than this, you'll be fine. I promise."

Exhausted, but reassured, Sam sagged against Dean's chest, still clutching his brother's shirt between his fingers and became aware of comforting circles once again being rubbed between his shoulders.

Sam closed his eyes, grateful beyond words that when it mattered, Dean dismissed his unspoken rule against touchy-feely crap; when it mattered, when Sam was sick or hurt or upset, Dean wasn't impatient or snarky or secretly storing ammunition to be used later for teasing and further embarrassment. When it mattered, Dean was just his big brother – and that made everything better.

"Thirsty," Sam sighed and felt Dean nod beside his temple.

"We'll get you some water."

"No." Sam weakly shook his head. "Juice."

Dean smiled and felt the limp, sweaty strands of Sam's hair between his fingers as he lightly rubbed the kid's head, wondering how many times tonight his little brother would remind him of his former toddler self.

"Cold water will help stop the bleeding, Sam. If you make it through the shower with no more incidents, then you can have your apple juice." He lifted his shoulder, gently nudging Sam's head as it rested there. "Deal?"

Sam opened his eyes, gave a hint of a smile. "Deal."

"Okay," Dean said, grasping Sam's shoulders and gently pushing him back. "Let's do this. Nice and easy, right? You should be completely empty by now, but I don't wanna take any chances."

"Ugh...me, neither," Sam mumbled as he allowed Dean to pull him to his feet and then just stood there, gaining his balance.

"Weebles wobble but they don't fall down, huh Sammy?" Dean teased affectionately, steadying his brother as they shuffled toward the door.

Sam rolled his eyes, then stumbled when it made him dizzy.

"Easy," Dean murmured, snagging their duffles on the way out the door as he helped his little brother to the bathroom down the hall, pleased – but not surprised – that towels and washcloths were already waiting along with two glasses by the sink.

Wordlessly, Dean filled one of the glasses and handed it to Sam, looking down at the mess on his shirt and jeans when he noticed his little brother's gaze.

"It's okay, Sam," he assured, knowing the kid was still upset about what had happened just moments before. "You're gonna get cleaned up, I'm gonna get cleaned up, and it's all gonna be fine. Okay?"

Sam still looked distressed but nodded slowly.

"Good." Dean pointed to the glass in Sam's hand. "Now go ahead. Slow and easy," he advised, watching as his little brother took a few careful sips.

Sam winced as he swallowed and coughed once.

"You good?" Dean asked, taking the glass and setting it on the counter.

Sam nodded as Dean stripped his t-shirt, still stuck to him with sweat, and shivered when the cool air struck his clammy skin.

"Open up, let me see," Dean said, tilting Sam's head back, angling toward the light. "It looks red and swollen back there, but I don't see any fresh bleeding." He released his grip on either side of Sam's head and frowned when the kid seemed to pale. "Whoa. You gonna hurl again?"

Sam seemed to consider the possibility.

"Sam?"

"Nuh-uh."

"You sure?"

"Mm-hmm," Sam responded, one hand on the counter by the sink, the other grasping the towel bar on the opposite wall as Dean began to remove his jeans and boxers.

Some part of Sam suspected he should be embarrassed that his brother was undressing him like he was three-years old and still needed help with bath time, but he was too sick, exhausted, and miserable to care.

Dean started the water, and then lent an arm to Sam as he stepped into the tub.

"Here," he said, handing over soap and shampoo from Sam's kit, and then sliding the shower curtain shut.

Dean listened to his little brother move around under the shower spray and pulled out a clean pair of boxers along with sweatpants, a sleep shirt, and socks for Sam and then began to strip his own dirty clothes. He held a washcloth under the sink's faucet, then wrung it and wiped it over his face, arms, and torso before patting dry and dressing in his own sleep clothes. He'd take a shower later – maybe tomorrow – but this would work for now.

Dean shouldered the duffles and scooped the dirty clothes up in one arm. "Sam, I'm gonna go take care of a few things in our room, okay? But yell if you need me. I'm just down the hall."

Sam rested his head against the tiled wall and closed his eyes, relaxing in the warm spray, but was startled when the shower curtain's corner was yanked back, revealing Dean's worried, yet irritated face.

"Did you hear me?"

Sam nodded.

"Then answer me."

"My throat hurts," Sam rasped, sounding like that was an understatement.

Dean softened immediately. _Duh, dumbass,_ he chastised himself.

"Sorry, kiddo. How about some pain meds and apple juice, huh?"

Sam nodded with the same enthusiasm Dean usually reserved for offers of hamburgers and hot chicks.

Dean chuckled, closing the shower curtain and leaving the bathroom door cracked as he entered the hall. He knew it would take Sam about ten more minutes to finish up, which meant he would have to hustle to change the sheets, dispose of the trashcan contents, get Sam's juice and pills, and...

Dean paused in the doorway of their room. "Pastor Jim?"

Jim finished tucking the flat top sheet under the mattress and turned. "How's Sam?"

"He's okay right now," Dean replied, setting the duffle bags in the chair by the door and crossing the threshold as his eyes swept the room, taking in the juice on the nightstand, the fresh trashcan nearby, and the pile of dirty linens on the floor. "I was coming back to do all of this."

"I know you were," Jim agreed, straightening the comforter on Sam's bed and then smoothing it back along with the clean sheet. "But you have more important things to tend to, so when I heard the shower, I came up to help."

Dean nodded, never really knowing how to respond to other people helping him care for Sam, even when those other people were longtime friends.

"Um...thanks."

"You're more than welcome." Jim smiled, gathering the soiled sheets from the floor and taking the dirty clothes from Dean's arms as he passed by. "I'm going to start a load of laundry and then warm up some cans of soup. Do you think Sam can manage chicken noodle?"

"Hard to say," Dean responded honestly, crossing to his leather jacket still on his bed. "Sam's picky on his best days." He pulled out the brown paper bag from the hospital and withdrew two of the pill packets. "And this is definitely not one of his best days."

"Understandable, but I'll bring up a bowl, and we'll see," Jim said shifting the laundry in his arms and turning to leave.

"Sounds good," Dean answered, placing Sam's pills beside the juice glass on the nightstand and noticing his phone.

Two back-to-back calls.

Both from John.

No message.

_Great,_ Dean thought, knowing he would catch hell later for having not called John immediately following the surgery – but he didn't care. Sam was his priority. Taking care of his little brother, making sure he was safe, settled, and comfortable; _that's_ what came first, and John Winchester could wait his fucking turn.

The water shut off down the hall.

Dean listened for a moment, then placed the phone back on the nightstand and went to check on Sam, realizing that "yell if you need me" probably wasn't the best advice given the kid's current condition. He could barely speak, much less yell.

The shower curtain rings clanked together as Sam pushed back the plastic fabric and climbed out of the tub, toweling off and reaching for his boxers and sweatpants. He had just pulled his t-shirt over his head and was reaching his arms through the sleeves when Dean appeared around the corner, giving him a once over.

"All done, Sam-I-Am?"

Sam smiled weakly at the childhood nickname and nodded as he rubbed the towel over his hair.

"Anymore visits from our friend Ralph?"

Sam wrinkled his nose, shaking his head and then sweeping his damp bangs out of his eyes before he sat on the closed toilet and pulled on his socks.

"Good. Jim's gonna bring up soup."

Sam scrunched his face.

"I know, princess, but a few bites is all I'm askin', okay?"

Sam looked doubtful but nodded as he stood.

"Good," Dean said, draping his arm over Sam's shoulders and switching off the bathroom light. "Food, pills – "

" – juice?"

Dean smirked. "One-track mind much?"

Sam shrugged.

"Yes, juice," Dean affirmed. "And then night-night time for Sammy."

_**TBC ~ As always, thanks for the reviews and alerts! And special thanks to those who have sent birthday messages! **_


	4. Chapter 4

Silence enveloped the house as Jim stood at the top of the stairs, staring down the corridor as blue-hued light flickered across the floor and muffled voices drifted to him from down the hall. It had been a little over two hours since the boys had arrived on his doorstep, and he was thankful that the worst seemed to be over for Sam right now.

The youngest Winchester had showered and changed clothes; had managed about half the soup and all of the apple juice; had taken his pain pills and antibiotic; and was beginning to drift off when Jim had excused himself earlier and taken the bed tray back downstairs to the kitchen. He had assumed Sam would be asleep by now, but he heard two voices mixed with those from the TV.

Curious, Jim walked down the hall, the soles of his shoes softly striking the wooden floor, and stopped just before the ajar door. He peered through the crack, his heart warmed at the sight of Dean propped against the headboard with Sam curled up beside him under the sheets. Sam's head rested against his big brother's chest, just under Dean's arm as it wrapped protectively around him, holding him close.

"Dude, there's no 'k' in 'Ramble On'!" Dean shook his head. "How do you get to be on _Wheel of Fortune_ if you're a dumbass?"

"Just because he doesn't know the answer to this category doesn't mean he's a dumbass," Sam responded, his voice barely a whisper.

"Because you're drugged and half asleep, I'm gonna forget you said that, Sammy."

"Not everybody knows Led Zeppelin songs, Dean. Some people don't even like them."

"Silence, blasphemer!"

Jim chuckled softly, immediately attracting Dean's attention. "Sorry. Didn't mean to eavesdrop."

Dean shrugged. "I knew you were there." He then nodded at the TV sitting atop the bureau across the room, inviting the Pastor into the room and into the conversation. "Do you know the answer to this?"

Jim pushed the door open and entered, focusing on the screen as words at the bottom declared the category to be "Song & Artist". "I'm assuming it's a Led Zeppelin song?"

"Only one of their best songs _ever_ – "

" – according to you," Sam interrupted softly.

"Shut up, Sam," Dean snapped. "Your favorite song is 'I Feel Pretty.'"

Jim shook his head. _These boys._

"Is not," Sam whined hoarsely and then coughed. "I like Zeppelin songs."

"Yeah?" Dean asked, sounding skeptical. "Which one?"

"'Going to California'."

Dean was silent for a moment, stunned by how quickly Sam answered. "Seriously?" He shook his head. "Why?"

Sam shrugged, thinking about his favorite lyrics. _Made up my mind to make a new start...Going to California with an aching in my heart...Someone told me there's a girl out there...With love in her eyes and flowers in her hair...Took my chances on a big jet plane...Never let them tell you that they're all the same...Standing on a hill in my mountain of dreams...Telling myself it's not as hard, hard, hard as it seems._

"Don't know," Sam finally answered, closing his eyes. "Just like it. Why do you like yours?"

"Because it kicks ass!" Dean answered automatically. "I mean...that's what we do – we ramble on. It's like our theme song."

_Mine's a tale that can't be told, my freedom I hold dear...How years ago in days of old, when magic filled the air...T'was in the darkest depths of Mordor, I met a girl so fair...But Gollum, and the evil one crept up and slipped away with her, her, her...yeah._

_Yeah,_ Dean thought bitterly, knowing the lyrics referred to Tolkien but always reminded of their mom and that night during that part. _Definitely our theme song._

"I'd like to solve the puzzle, Pat," the male contestant declared, drawing Dean's attention back to the TV. "'Ramble On By Led Zeppelin.'"

Dean rolled his eyes as the audience clapped. "Yay for you...dumbass."

Jim arched an eyebrow, but Dean just grinned, wondering if the Pastor ever regretted their pact – that when Dean turned 18, Jim would stop lecturing about his "abundant use of foul and offensive language."

"I could've called him something worse," Dean teased good-naturedly.

"Yes. I know," Jim answered laconically, mock sternness in his voice. He knew Dean tried to tone it down around him, and truly, that's all he could ask for when it came to the oldest Winchester brother.

Dean laughed softly and then looked down at a suspiciously quiet Sam.

"He asleep?"

Dean nodded, sweeping slightly damp bangs from Sam's forehead. "Yep. 'Bout time, too."

"He always did fight sleep," Jim commented, checking the salt line by the window and noticing the rain had finally stopped.

"Still does," Dean answered, shifting under his brother's weight.

Jim smiled. "Need anything before I turn in?"

As if on cue, Dean's phone began to vibrate, clattering against the nightstand as it inched its way toward the edge and then abruptly fell to the floor.

Sam startled awake, his brow furrowed as he glanced up at Dean.

"Damn it," Dean muttered, aware of Jim moving to retrieve the phone but focused on his little brother.

"D'n..."

"It's okay, Sammy," Dean soothed, calming hand rubbing his brother's back. "Just the phone. Go back to sleep. You're okay."

Sam looked puzzled, his hand fisting Dean's shirt, curling around the amulet, tangling in the black cord and then he relaxed as the combination of exhaustion and medicine swept him back under, his features smoothing out in sleep once again.

"Missed call...Dad," Jim read from the phone's display.

"He'll call back," Dean assured sarcastically, taking his phone from the Pastor. The words had no sooner left Dean's mouth than the phone started vibrating again. "See?"

Jim nodded and turned to leave. "I'll be down the hall, if you need anything. Good night," he said, closing the door behind him.

"Thanks, Jim," Dean responded, then sighed and answered the call. "Hey, Dad."

"I thought I told you to call me."

Dean narrowed his eyes, unexpectedly and instantly pissed at John's tone, which implied that their dad was more annoyed by his order being disobeyed than by being kept out of the loop on Sam's condition.

"Yeah, I know, but I've been busy."

"With what?"

Dean felt his blood pressure rise. _With what? Was he fucking kidding?_

"With Sam, Dad."

"Oh," John responded, sounding as though he had indeed momentarily forgotten about his youngest in his annoyance of being disobeyed by his oldest. "How is he?"

Dean glanced down at his little brother snuggled close to his chest. "He's fine. The last few hours have been rough, but he's fine right now."

"Good," John replied. "I told you it was just routine surgery."

Dean said nothing, annoyed that John kept using that phrase.

"Where are you now?"

"Pastor Jim's."

"Why?"

Dean shook his head at what seemed obvious. "Because Sam just got out of surgery a few hours ago, Dad. He's been sick and now he's sleeping. He needs to rest and recover."

"He can rest and recover in the car, Dean. I want you both back on the road in the morning. Meet me in – "

"No," Dean interrupted, his voice louder than intended.

Sam twitched, then rubbed his face on Dean's chest and sighed.

Dean lightly patted his little brother's back and listened to the rumble of their dad's truck in the silence over the line.

"Dean – "

"No, Dad. I mean it." Dean's grip tightened on the phone. Following orders with no argument was protocol; but Sam had always been the exception to that rule. "Sam needs to recover for at least a week, preferably two. He stays here."

"Dean – "

"Dad, I'm not arguing with you about this," Dean stated matter-of-factly. "You told me earlier today to handle it, so I did. Sam's had the surgery, and now he needs to recover. Not recover on the road, but recover here. Period. End of discussion."

There was more silence as Dean waited for John to read between the lines: _don't fuck with me about Sammy_.

John sighed harshly. "Fine. Sam can stay, but you leave in the morning and meet me in Ida Grove, Iowa."

"What? Why? What happened to the hunt over in Fairmont?"

"Done. Simple salt and burn."

"What's in Ida Grove?"

"Not sure. Probably gonna take a few days of research to figure everything out, plus interviews and all that crap. That's why I need you to leave out as soon as it's light."

"Dad, I can't leave." Dean glanced down at his brother. "Sam needs me."

"I need you too, Dean."

And there was the story of Dean's life.

Dean sighed.

"Listen, I know it's hard for you to leave Sam when he's sick, but he's gonna be fine. The worst is over, and Jim will watch out for him. I need you in Ida Grove to watch my back, Dean."

Dean nodded, his fingers absently rubbing small circles on Sam's shoulder. He could hear the logic in John's words, but he still felt torn.

What if something happened to Sam while he was gone? The doctor had mentioned complications, and if any recovery were going to get complicated, it would be Sam's.

Then again, what if something happened to their dad because Dean didn't join him and wasn't there for backup?

Dean sighed again. _Shit._

"Dean."

"Yeah, Dad. I get it."

"So I'll see you in the morning?"

Dean hesitated, staring down at Sam.

"Dean?"

"Yes, sir. I'll be there."

"Good. It's about a three-hour drive to Ida Grove from Blue Earth, so I'll plan to meet you at the library at 0900 hours."

"Yes, sir."

"Take care of Sam and be sure to thank Jim. I'll be in touch," John promised before ending the call.

Dean stared at the phone, then glanced down at Sam as his little brother shifted in his sleep, burrowing impossibly closer to his side, and causing Dean to smile affectionately.

A sick Sam was a clingy Sam, and a clingy Sam always clung to Dean.

Dean sighed, resting his chin on top of Sam's head, feeling the heat radiate off his little brother and wondering if he had just made the right decision.

"I'd like to buy a vowel," a female contestant excitedly announced, causing Dean's attention to flicker to the TV he forgot was still on. "An 'a,' please."

Vanna touched the five lighted squares on the puzzle board, filling in most of what was left of the "Phrase."

"I'd like to solve the puzzle," the same female contestant said, barely able to contain herself. "Between A Rock And A Hard Place."

Dean snorted and shook his head. _She could say that again._

**_TBC_**

**_Thanks for reading, reviewing, and alerting! One more chapter to go before it hits the fan for Sammy..._**


	5. Chapter 5

Dean closed his eyes, leaning into the shower spray and feeling the hot-as-he-could-stand-it water flowing over his body, loosening stiff muscles that were sore from sleeping in one position.

He had awoken 20 minutes ago, hot from a clingy, fevered little brother and achy from having slept propped against the headboard, holding and soothing said little brother through the night. Not that Dean was complaining. He would willingly and gladly suffer discomfort for the sake of Sam, and as far as he could tell, Sam had slept soundly for the past few hours – so soundly that he didn't even twitch when Dean had eased out from under him.

The water began to turn lukewarm, and Dean sighed with regret. He sometimes felt as though the shower was his only sanctuary, and he was reluctant to leave it, especially this morning. A three-hour drive, John's oh-so-cheery disposition, and mountains of research didn't exactly give him much to look forward to.

And then there was the issue of leaving Sam.

Dean opened his eyes and rubbed his face with both hands. He knew he was being ridiculous. It wasn't like he was leaving Sam with a stranger; Jim had taken care of under-the-weather Winchesters plenty of times. But the Pastor had never flown solo with a post-op, fevered, sick, clingy, where's-my-apple-juice Sammy, and that's what bothered Dean.

Much of dealing with Sam was reading Sam, and Dean was concerned Jim didn't have a firm grasp on that particular manual.

Sighing, Dean ran one hand through his wet hair and then reached for the shower knob, stopping the flow of the quickly cooling water. He toweled off, making a mental list of everything he needed to go over with Jim before he left, and then shaved. He pulled on his worn jeans and his black t-shirt, missing the weight of the amulet against his chest and then smiling at the reason.

Before he had fallen asleep the night before, Sam had fisted the gold charm – a sick Sammy habit that Dean always viewed as the comforting equivalent of toddler Sammy sucking his thumb – and during the night, while his little brother's body had weakened from fever, his grip had not. Having no luck in prying Sam's fingers from the amulet, Dean had decided to just take it off, slipping it over his head and leaving it in his little brother's grasp as he had eased out from under him.

Dean shook his head fondly as he gathered his kit and sleep clothes and then opened the bathroom door, wisps of steam swirling in the rush of air. He heard movement downstairs and glanced to the left, noting that Jim's bedroom door was now open at the end of the hall. He inhaled deeply, knowing the faint aroma of brewing coffee further confirmed that Jim was awake and in the kitchen.

Dean switched off the bathroom light and entered his and Sam's room, quickly stuffing his kit and his clothes into his duffle before padding down the stairs in his bare feet.

As expected, Jim was dressed and standing by the counter, alternately supervising the coffeemaker and glancing out the window at the gray sky.

"Morning," Dean greeted on his way to the fridge.

"Morning," Jim returned, facing him and then gesturing at his chest. "Missing something?"

Dean shook his head. "Sam has it."

"I see." Jim smiled warmly, needing no further explanation. "Everything okay upstairs?"

Dean nodded, grasping the neck of the apple juice bottle and crossing to the cabinet by the sink. "Seems to be, but I guess we'll know for sure in a few minutes when I wake him up. He was a little restless last night, but that's Sam just about any night, so I'm not too worried." He could feel Jim watching him as he took a stout glass from the shelf. "What?"

Jim shrugged, leaning against the counter. "Just waiting."

Dean's eyes narrowed. "For what?"

"For instructions."

Dean arched an eyebrow.

"This _is_ the changing of the guard, right?"

Dean laughed, setting the glass on the counter. "That obvious, huh?"

Jim was silent a moment, causing Dean to look at him.

"John doesn't call for chats."

"No, he calls with orders," Dean responded, surprised by the fierce bitterness in his voice.

"And you resent that?" Jim asked automatically, forgetting he wasn't counseling a distressed parishioner

Dean's hand halted mid-pour. He looked surprised at the question, but answered. "I resent having to leave Sam."

"He'll be fine, Dean. I'll take care of him," Jim assured.

"I know," Dean agreed, topping the juice bottle. "I just resent having to choose...having to constantly choose...and then second-guessing if I made the right choice."

"You know, Dean," Jim began, closing the gap between them. "Choosing between right and wrong is easy when the wrong in question virtually hisses its malevolence, and the good all but glows angelically. But most calls are far closer – often agonizingly so – and few of us live our lives by a scheme of rigidities that brooks no allowance for circumstances."

Dean snorted and shook his head. "Meaning?"

"Meaning," Jim repeated for emphasis, "that all we can do is what we think is right at the time based on the situation. I know you don't like leaving him, but Sam is safe here; you know he's in good hands. Your dad, on the other hand, is who knows where – "

"Ida Grove," Dean informed.

Jim paused. "He's three hours away, and given the situation, most likely needs you more than Sam does right now."

Dean sighed, absorbing the Pastor's advice. "Maybe," he acquiesced, crossing to the fridge to return the juice. He glanced mischievously at the Pastor. "But depending on how long I'm gone, _you_ might be the one in need."

"And why's that?" Jim asked suspiciously.

"Because Sam's a moody little bitch when he's sick."

"Nonsense," Jim scoffed. "He's a joy to be around."

"Yeah...sure," Dean drawled, rolling his eyes.

Jim shook his head, wondering if Dean realized his sarcasm did nothing to decrease his transparency when it came to how he felt towards his little brother.

"I'm not concerned," Jim replied, turning to take two mugs from the cabinet. "Besides, he'll probably sleep the entire time you're gone."

"If you're lucky," Dean agreed. "And if not..." He shuddered dramatically. "You've been warned."

Jim chuckled, pouring coffee into one of the mugs.

"None for me right now," Dean said, taking the juice-filled glass from the counter. "I'm gonna go back up, give Sam his meds..." _Say goodbye._ "Then I'll be back to go over everything." _Not that you can't read post-op info sheets and dosage instructions yourself, but still..._

"Sounds good," Jim responded, his chilled hands wrapping around the warm mug as he sauntered out of the kitchen. "I'll be in my study."

Dean nodded and went upstairs, back to his and Sam's room. He set the glass on the nightstand before crossing to sit on his own bed. He pulled on his socks and then his boots, glancing at Sam on the other bed as he tied the laces. His little brother hadn't budged, still sleeping soundly on his stomach – another sign of sick Sammy.

If Sam was well, he slept on his back; if he was injured, on one side or the other; and if he was sick, his stomach.

Dean pulled the hem of his jeans over his boots, wondering if anyone else knew those tidbits about his brother, and then immediately answered himself – _No. _

No one knew Sam like he did, and here he was leaving the kid not even 24-hours after he had undergone surgery.

"This sucks," Dean said aloud as he crouched at the edge of Sam's bed and gently rubbed his little brother's back. "Sammy-Sam-Sam...wake up, kiddo."

Sam shifted under Dean's touch, his right arm disappearing under the pillow, his left hand – still clutching the amulet – drawn closer to his chest. His nose wrinkled, his face scrunching much like it did when he was a baby and was just waking up. He opened his eyes, then blinked drowsily at Dean.

Dean smiled warmly. "Morning, Francis."

Sam sighed and closed his eyes.

"Hey." Dean nudged his little brother's shoulder. "You with me?"

Sam swallowed, then winced.

Dean frowned. "Sam..."

"Hmm?"

"Open your eyes."

"M'sleepin'."

"Sam."

Sighing, Sam opened his eyes and stared at Dean expectantly.

"How you feelin'?"

"Tired," Sam stated flatly, the _duh_ implied.

"How 'bout your throat?" Dean asked, also unnecessarily. He could tell just by the way Sam sounded.

Sam stared at him.

Dean scowled. "Am I gonna have to ask you everything twice?"

Sam scowled back.

"Hey. Ditch the bitchface and just answer me. How's your throat?"

"Hurts."

Dean nodded. "Worse?"

Sam shrugged.

Dean nodded again, taking the gesture for the "yes" it was – and didn't that just make him feel all kinds of good about leaving.

"Scale of one to ten..."

Sam hesitated.

"Sam."

"Ten."

Dean sighed. The post-op info sheets had said the pain might be worse up to three days after surgery, but still..._s__hit._

"It's time for your antibiotic and pain meds. That'll help." Dean reached behind him to grab the brown paper bag still on his bed from the night before and took out two pill packets. "Sit up."

Sam closed his eyes and grunted his displeasure at that idea.

Dean smirked. _Moody little bitch._

"Sam, seriously. Sit. Up. I'm not gonna Heimlich Maneuver your ass if you choke on pills."

Sam remained motionless.

Dean sighed and glanced at the nightstand, grabbing the glass. "I brought apple juice."

Sam cracked one eye and sought proof, finding aforementioned juice sitting patiently in a glass mere inches from his face. He didn't verbally respond but rolled over, grimacing as he did, and propped up on one elbow long enough to swallow the pills and then drain the glass.

"More?"

Dean laughed, rolling his eyes as he set the glass back on the nightstand. "Maybe later, you juice junkie."

Sam frowned, then settled on his stomach, moving restlessly beneath the sheets. "M'hot."

"I know," Dean said, feeling Sam's flushed cheek, then his forehead. "You'll probably keep this fever for another day or two, kiddo."

And while that was also considered normal according to the info sheets, it did not sit well with a soon departing big brother.

"Anything else hurt besides your throat?" Dean asked, as he picked strands of hair from Sam's lashes and then swept his bangs aside.

Sam blinked at him.

Dean nudged his little brother. "Hey. You hear me?"

"Stomach hurts."

Dean narrowed his eyes. "Like, I'm-gonna-puke-again hurt or I'm-sore-from-puking-so-much-yesterday hurt?"

Sam didn't answer right away, and Dean held his breath. There was no way he was going to leave a puking Sammy. John Winchester would just be shit out of luck if Sam answered the first way.

"Sam?" Dean prompted, knowing his little brother was reaching his patience limit in self-assessment Q&A.

"Just sore," Sam rasped and then coughed. "I think."

Dean felt the rise of panic. "You think? What the hell does _that_ mean?"

"I don't know, Dean," Sam snapped hoarsely, then coughed again, closing his eyes. "I just don't feel good," he whined, pushing his face into the pillow to muffle a whimper.

Dean tightened his jaw against the emotion that surged through him at seeing Sam so miserable. He hated this. Hated when Sam was sick; hated when he couldn't make him instantly better; and hated that he had to leave him like this.

"I know, Sammy," Dean soothed, softening as he always did when Sam used that tone. His knees popped as he stood from his crouched position and sat on the bed next to Sam. "It's okay. C'mere..."

Without hesitation, Sam resumed the position he had been in all night, curled against his brother's side, head resting on his chest. Sam's forearm stretched across Dean's stomach, and as his hand moved up and down with each of his brother's breaths, he noticed the gold charm and black cord clutched in his fingers.

Sam smiled weakly – this not being the first time he had been sick and woken up holding the amulet – and released it into Dean's right hand as it rested on the mattress.

Dean felt the cool metal of the charm and watched the cord coil in his hand. "Giving it back already?"

Sam nodded. "I want you to have it," he whispered, echoing the words he had said when he first gave it to his brother a few Christmases ago, just like he always did each time he gave it back.

Dean returned the nod, then spread his fingers in the cord and slipped it over his head, feeling the familiar weight settle on his chest beside the other familiar weight – Sam.

Dean smiled fondly as his little brother leaned more heavily against him, and he knew Sam was drifting off to sleep. As if to confirm it, his brother yawned and then burrowed deeper, causing Dean's smile to widen.

On most days, Sam was indeed a 13-year old moody, bitchfaced pain in the ass. But he was still Dean's little brother. And when he was sick, he regressed about seven or eight years to a kid who just wanted to be close to his big brother – and although Dean might bitch to the contrary, he didn't mind one bit. One of his weaknesses was needing Sam to need him, and he dreaded the day his little brother would stop seeking him as a refuge.

Out of affectionate habit, Dean began to rub his little brother's back, marveling – not for the first time – how something as simple as him sitting here with Sam beside him could make him feel so content. Not that he'd ever tell anyone that...

Dean sighed, wishing he could stay but knowing he was already late.

"Don't get too comfy, Sammy."

Sam sighed drowsily. "Why?"

Dean hesitated. This was the hard part. "Because I have to leave."

Sam said nothing, but his body tensed, wide eyes staring up at Dean.

"Dad called," Dean responded, as though that explained everything – and it did.

Sam continued to stare at him, absorbing the implication of those two words.

"Everything's gonna be fine, Sam," Dean assured, not liking that he could feel Sam's heart beat increasingly fast against his own chest. "You'll stay here with Pastor Jim. I'll go help Dad finish up this hunt over in Ida Grove. And when I come back, you'll feel better, and we can hit the road."

Sam nodded but remained silent, head still resting on Dean's chest as his fisted hand rubbed his thumb over his forefinger.

Dean noticed the nervous habit and nudged his brother. "Hey. You gonna say something or what?"

More silence stretched between them, and Dean began to wonder if Sam was going to answer him when his little brother finally spoke.

"Be careful."

The words were whispered, but Dean heard them along with the usual unspoken message of love and concern and your-ass-better-come-back-alive.

"I will be. I promise." Dean patted Sam's back and eased out from under his little brother for the second time that morning. "I'll be back before you know it, but while I'm gone, you rest and get better, huh?"

"'Kay."

"And you tell Jim if you start to feel worse or if something doesn't feel right, got it?" Dean said as he crossed to the chair by the door and shouldered his duffle.

"Yeah."

Dean crossed back to the beds, retrieving his leather jacket along with the brown paper bag and pinned his little brother with a stern gaze. "I'm serious, Sam – none of this Winchesters-don't-admit-weakness bullshit. Tell Jim if something's wrong, understand?"

Sam nodded against the pillow, eyes closed.

"Say it, Sam."

Sam swallowed painfully.

"Sam..."

"I understand," he murmured.

"Good. That's my boy," Dean said as he tousled his little brother's hair and knew that Sam was asleep again when his hand wasn't swatted away.

Dean stared down at his brother, feeling strangely sad and sentimental, before reminding himself that he was being ridiculous – Sam would be _fine_ – and to just _leave_ already.

"See you in a few days, Sammy," Dean promised, crossing to the door and closing it behind him.

**_TBC _**

**_It's fitting that I post a chapter in which Dean leaves on the day that I leave town, too. I'm taking my laptop and flashdrive, so hopefully I will still be able to update on Friday. If not, though, you'll know why..._**

**_Thanks for the reviews, alerts, and PMs - I love hearing from all of you!_**


	6. Chapter 6

Sam awoke on his stomach and slowly opened his eyes, then closed them immediately. His head pounded mercilessly, and he knew the moment he moved, he would be combating nausea. He swallowed convulsively, wincing at the pain in his throat, as he remained motionless on the bed, remembering where he was and why.

Pastor Jim's...because Dad and Dean were on a hunt...and he was recovering from a tonsillectomy.

Sam sighed as he recalled the whirlwind of the past four days: admitting a sore throat, Dean freaking over the white spots, and being hauled to a clinic for the official diagnosis. Then came surgery and being whisked away from the noise of raised voices and too many questions to the comforting rumble of the Impala to here...the relative silence at Jim Murphy's.

Sam didn't remember much – memories jumbled or altogether lost in a haze of pain and medication – but he knew that he had had surgery on Tuesday, Dean had left on Wednesday, today was Saturday...and he felt worse now than he did before.

_I'm so sick of being sick, _he thought miserably, annoyed that it was taking so long for his body to recover and bounce back from what his father had described as "routine surgery."

Sam shifted on the bed and wondered idly if the surgeon had also said those exact words, or if that was just how his father had chosen to describe what he undoubtedly deemed a waste of time.

"Only you would have a sore throat that required surgery to fix, Sam," his dad had said over the phone Wednesday evening, and although his tone had been light, Sam had wondered if there was a jab – intentional or not – hidden beneath.

He used to be able to tell when his father was teasing – when he was showing rare affection in one of the only ways he seemed to know how – but as he got older, Sam suspected that everything his father said to him was laced with disappointment.

_If you were only stronger, Sam...more like Dean...more like me._

"I'm sorry," he had responded as quickly and as naturally as a knee jerk, his voice still weak and raspy from surgery. "For screwing up the hunt," he had added when his apology had been met with silence on the other end of the phone.

He had held his breath for as long as John had held his silence.

"It's alright," his dad had finally responded. "You rest up. Here's Dean."

Sam opened his eyes and sighed. It seemed like John was always passing him off to Dean.

Sam swallowed another sigh and turned his head into the soft pillow. He retreated in the warm folds of the comforter, drawing a deep breath and then hissing at the sudden razor-sharp pain that dug into his ribs, reminding him of his fall on the stairs the night before.

Sam grimaced at the memory, recalling the explosion of pain when his stomach had collided with the step.

One minute he was slowly ascending – ridiculously and frustratingly exhausted from his two-hour venture downstairs for dinner when Bobby had unexpectedly stopped by – and the next minute he was quickly descending to meet step #8 up close and personal.

He had sprawled there for several minutes, winded and weak but determined to get his shit together before Jim came back inside from seeing Bobby out. While it took talent to fall _up_ the stairs, this was not a skill he had wanted to demonstrate for the Pastor.

Not able to stand, he had crawled up the remaining six steps and then clutched the railing, hauling himself to his feet. Stooped and dizzy, he had wrapped one arm protectively around his pulsating, aching abdomen while using his other arm to brace himself, fingers skimming the wall as he had made his way back to his room.

Sam blinked, trying to remember what had happened after he had collapsed on his bed, but he was blank. Sleep was merciful and had undoubtedly swept him away.

But now he was awake and the internal pain played a distant second to the ache in his head and the heavy weight of exhaustion that seeped into his bones. It felt as though his blood oozed like molten lead through his veins.

"Tell Jim if something doesn't feel right, got it?" Dean had said before he left.

And although Sam had agreed, he doubted he would mention his fall last night or the resulting pain this morning to Jim. It wasn't that bad. He just needed to get up, walk it off, and suck it up.

With exaggerated care, Sam sat up and braced himself on the soft mattress with his hands, letting his body acclimate to the position before swinging his legs over the side of the bed. He had no idea what time of day it was but assumed it was late in the morning, judging by the way the sunlight shone through the window and stretched across the floor.

As he continued to stare down, he noticed he was still wearing the dark green socks from the day before but now had on his sweatpants and t-shirt that he usually slept in. Not remembering details beyond crossing the threshold of his room, but knowing he wouldn't have had the strength to change clothes, only left one explanation – Jim – and Sam didn't know whether to feel grateful or mortified. The Pastor must have checked on him before going to bed and having found him literally passed out on the mattress, made him comfortable and tucked him in.

"Just like a freakin' baby," Sam muttered, knowing Jim wouldn't embarrass him further by mentioning it but still annoyed with himself.

Confused and sluggish, Sam eased himself to his feet and stumbled over to the closet, opening the door. His muscles protested the motion, stubbornly remaining stiff and sore, and his shoulder joints, especially on the left, radiated with pain at the slightest movement.

Sam sighed as he dressed, his fingers fumbling with the zipper of his jeans and the buckle of his belt, as he set his mind against the lingering aches and fatigue.

_I don't have time for this,_ he thought irritably.

While he didn't have any physical training today – thank you, tonsillectomy – he did want to make good use of his extra time with Pastor Jim to go over some of the more complicated Latin texts.

Sam removed his sleep shirt, noticing his reflection in the mirror on the closet door, and paused, surprised by the faint blue bruises on his forearms and torso. Frowning, he lightly skimmed his fingers over the discolored flesh, gasping as he found they were painful to the touch.

"You are such a klutz, Sam," he whispered to himself.

"Sam..."

Sam jerked his head in the direction of Jim's voice as it floated up the stairs, instantly regretting the quick motion. He braced himself against the doorjamb of the closet and closed his eyes as he rode out the nausea. His breath came in short, harsh gasps, each one causing a stab of hot pain under his ribs.

"_Holy_...guh," he panted. "What the hell..."

"Sam?"

Sam struggled for a controlled breath. Jim's voice sounded closer and held a hint of concern. If he didn't answer, he knew the Pastor would come upstairs – and that was the last thing Sam needed.

"Coming..." he managed and slowly opened his eyes as he eased himself back to a standing position.

As quickly as he dared – and as his sore, fatigued body would allow – Sam finished dressing, pulling on a faded navy blue hoodie. He ran a hand over his forehead, under his bangs, down his cheek and over his chin, observing his features and deciding that aside from his sleep-tousled hair and the unusual pallor of his skin, he didn't look too bad. Dean would know that something was off – but Dean wasn't there.

Sam snorted softly, unsure if it was good or bad that his charade could continue unnoticed, and slowly padded down the steps, his socks allowing a silent approach to the kitchen.

"Morning, Sam," Jim said cheerfully as he continued to scramble eggs at the stove. "How's your throat this morning?"

"Better," Sam answered truthfully. That was the least of his worries right now.

"Glad to hear it. You do sound a little better," Jim replied, turning the eggs with the spatula. "I'm sorry to wake you, but you need to eat so you can take your antibiotic and pain pill."

Sam gave him a half-hearted smile and leaned against the counter. "Sorry I slept so long. You should've gotten me up before now."

Jim sighed, as he transferred the eggs to a plate. "You're here to rest, relax, and recuperate, remember? In a few days, your dad and Dean will be back, and you'll be on the road again."

Sam nodded, watching the Pastor pour a glass of apple juice. He was being spoiled, that was for sure. He'd barely done anything for himself while he'd been at Pastor Jim's.

"Have they called?"

Jim shook his head, placing the plate and glass in front of Sam before turning away to collect Sam's medicine. "No, but I'm sure they're fine."

Sam nodded but said nothing. He knew that it was sometimes impossible to get a signal, depending on which backside-of-nowhere his family ended up, but still...

Sam sighed and looked at the eggs, immediately pushing them away.

Jim raised an eyebrow as he returned with Sam's pills. "Not in an egg mood this morning?"

"Not really." Sam swallowed. "Sorry."

"That's fine." Jim turned back towards the stove. "I'll fix you something else."

"No, that's okay. I really don't want anything."

"You have to take those with food, Sam," Jim said, indicating the pills resting on the counter beside the juice glass. "We don't want a repeat of the last time you took them on an empty stomach."

Sam wrinkled his nose, feeling his cheeks flush pink. No, they certainly didn't. Throwing up with Dean was one thing; throwing up with Jim was...embarrassing beyond words.

"I know, I just..." Sam trailed off, unsure of what to say. If he confessed how he was feeling, if he told about his fall and the intense pain and lingering exhaustion and those weird bruises on his stomach and chest, he would be headed to the hospital – no doubt about it – and he had already caused enough trouble over the past few days with his illness and surgery and convalescence.

At his continued silence, Jim frowned and turned to fully face the youngest Winchester. This was more than just Sam's usual picky eating habits. Sam was pale and looked exhausted as he leaned heavily against the counter, as though that was the only thing holding him upright.

Jim rounded the counter and placed a hand on Sam's forehead. "You sure you feel okay?"

Sam smiled lazily up at Jim, too sluggish to shy away from the Pastor's hand and too comforted by the contact to even want to. "I'm fine. Just a little tired." He pushed away from the counter, swallowing a hiss of pain as his sore muscles protested the motion. "I need to get started on that Latin."

Jim watched as Sam moved slowly toward the doorway. "Hold on a minute, Sam."

Sam stopped and turned expectantly.

"I don't like how pale you are this morning."

"Jim – "

" – and you felt a little warm, too."

"Pastor Jim, really – "

Jim held up his hand to stop any further protest. "I think you should go back to bed for a while."

Sam sighed. "But I want to go over those texts so that Dad – "

"Sam, John wouldn't want you working on anything if you were sick."

Sam looked doubtful.

"And don't even get me started on Dean's reaction..." Jim continued.

"But I'm not sick."

"Maybe, but you're certainly not well, either." Jim approached his young charge and gently rubbed his shoulder. "Recovery takes time, Sam – even for a Winchester."

Sam smiled in spite of the sting Jim's contact caused as hot pain spread across his left shoulder.

Jim returned the smile, pleased that his comment had momentarily lightened Sam's mood. "Listen, you go back to bed. I'm heading out for a little bit, and if you're not up when I get back, I'll wake you. Just rest for another hour or so, and then we'll revaluate how you feel, okay?"

Sam stared at him before slowly nodding. Going back to bed sounded good. Just the short walk down the stairs and then leaning against the counter had taken its toll.

"Okay."

Jim nodded his agreement, grabbing his keys and cell phone as he watched Sam ascend the stairs. "If you need anything, call me. I'll just be over at the church."

"'Kay," Sam mumbled as he disappeared around the corner and heard the door slam as Jim left the house.

The climb back up the stairs had tired Sam more than he expected. By the time he had crested the top step, he was breathless, as if the air had become too thin to breathe. A sudden wave of dizziness sent him staggering against the wall, his legs weak, his body trembling. He closed his eyes, leaning heavily against the solid wall and waiting for the dizziness to pass.

After a few minutes, Sam pushed away from the wall and steadied himself, taking deep breaths, forcing air into his lungs and trying to satisfy his overwhelming need for oxygen.

A fine sheen of perspiration glistened on his forehead, and Sam abruptly wiped it away, annoyed that his hand trembled, confused and scared by how miserable he felt, and desperately wanting his brother.

In a déjà vu of the previous night, Sam made his way to his room and sank into the soft mattress of his bed, exhausted.

"Dean..." he whispered, knowing his brother wasn't there, but somehow drawing comfort in calling for him. "Something's wrong."

He closed his eyes, the comforter absorbing his tears as he fell asleep.

_**TBC**_


	7. Chapter 7

Sam had hoped that the pain and weakness would be gone when he woke again, but it was not to be. His eyes burned as he squeezed them shut, his focus turned within, taking a mental inventory of his body, of what still hurt and realizing he felt worse than before.

Sam blinked drowsily and slowly sat up, his stomach, chest, and left shoulder screaming as pain sliced through them. Taking shallow breaths, he sat on the edge of the bed as he did earlier that morning, staring at the floor and waiting for the pain to subside.

It didn't.

The sun had moved to the opposite side of the room, and Sam knew that it must be late afternoon by now. Maybe 4:00...probably closer to 5:00. He listened intently but heard no sounds of movement in the house. Did that mean Jim was still at the church and he was alone?

_Dean wouldn't like that,_ Sam thought as he carefully stood up, shutting his eyes once again as a wave of dizziness swept over him. After several minutes, he cautiously opened them and moved toward the closet door, peering into the mirror.

Pulling up his hoodie, Sam was alarmed to see even more dark blue bruises on his torso, especially on the upper left side of his chest. He looked closer and was relieved to find no such marks on his face or neck, but his relief was short-lived as he noticed that he was still extremely pale. Even his lips had lost their color, and he had dark smudges under his eyes.

_I look like shit_, Sam thought.

And he knew Dean wouldn't like that, either.

Sighing, Sam lowered his hoodie, wondering where he was going to find the energy to make it downstairs – and how he was going to placate Jim once the Pastor saw him.

Moving abnormally slow, Sam shuffled out the door and down the hall, bracing against the wall, his forearm gliding along the slightly wrinkled wallpaper until he reached the stairs, sighing again at the enormity of the task ahead of him.

Taking one step at a time and resting for considerable periods in between – because he knew he wouldn't survive another fall right now – Sam made his way down the stairs. Each step was a victory over the unrelenting torture of breathing and moving. A constant suffocating pressure in his chest kept him from taking anything but shallow breaths, and even those cost him agonizing pain and an immense amount of energy to accomplish. It took him a long time to inhale and even longer to exhale, as if he was pushing against a vacuum. His heart slammed painfully in his chest, and the slicing sensation beneath his ribs was almost more than he could bear.

As he reached the last step, Sam stopped, his original goal of the sofa completely abandoned as he saw the phone on the end table. He stared at it, his frantic mind seizing on one thought: _call Dean_.

Sam swallowed, momentarily choked by his panting breaths, his knuckles turning white as he gripped the banister trying to regain his balance. He squeezed his eyes shut against the lancing pain in his stomach and chest, trying to gulp air, his breath catching in his sore throat.

He was exhausted and wondered how much longer he would be able to remain upright, wondered if he would even be able to make it to the phone, to dial the number, to say the words when Dean answered.

Through his hazy thoughts, Sam heard a car door slam and then heard footfalls mounting the porch steps and approaching the door. For a split second, he wondered if it was something evil coming to claim him...but at this point, it didn't matter. He stood frozen in place, his body refusing to move, refusing to be pushed anymore.

"Hey, Sam," Jim greeted as he opened the door and entered the house. "Sorry I'm late, but I stayed longer than I expected at the church and then I stopped by the store to see if I could find something you might want to eat since you skipped breakfast and really need to take those pills." He crossed to the kitchen to deposit the grocery bags he carried. "Are you feeling any better?"

Sam remained silent, allowing Jim's voice to wash over him like warm water, soothing his fear, easing his anxiety. He wasn't alone. Jim was here. Jim could call Dean. Dean would know what to do.

Sam opened his mouth to speak, but nothing came out. His silence must have caused the Pastor to worry, because Jim appeared a few seconds later, standing in the doorway of the kitchen.

"Sam?"

Sam breathed has deeply as he was able. "Pastor Jim, I..."

His voice trailed off, words swept away in a jumble of incomprehensible thoughts as an opaque curtain descended before Sam's eyes, blurring his vision. He felt his grip loosening on the banister as dizziness hit him with a staggering force, and he swayed.

"Sam?" Jim quickly moved toward Sam and grasped his shoulders. "What's wrong?"

An expression of panic, of frightened, helpless confusion crossed Sam's face before his knees buckled.

"Sam!" Jim yelled, catching the kid as he collapsed.

Sam's head limply flung back as it rested in the crook of Jim's arm, the muscles of his neck stretching, his mouth parting slightly as his jaw slackened in unconsciousness.

For a stunned moment, Jim held Sam closely, bearing the weight of the youngest Winchester, before lowering him to the floor. Sam was astonishingly still, his pale complexion a sharp contrast to the dark wooden floor beneath him.

"Sam!" Jim called, placing his hand on Sam's forehead, feeling clammy skin and damp bangs.

The Pastor trailed his fingers along the smooth contours of Sam's jaw and firmly pressed them against his neck, feeling a fast pulse galloping under his fingertips. Soft gasps escaped from the kid's pale lips as Jim reached for his phone because he wasn't taking any chances. Not with Sam.

"9-1-1. What's your emergency?"

* * *

Jim stood at the bottom of the stairs, his hands laced tightly together as he forced himself to remain in place and out of the way as the EMTs assessed Sam.

"Sir?"

Jim's attention flickered to the EMT standing before him.

"My name is Steve, and I need to ask you a few questions."

Jim nodded.

"What's his name?"

"Sam."

"Has he been ill recently?"

Jim nodded again. "Yes. He had his tonsils out about four days ago."

"Any medications?"

"Just antibiotics and painkillers."

"Any bleeding or high fever?"

"He felt warm this morning."

"Any breathing problems or signs of dehydration?"

"Not that I've noticed."

"Does he have any other medical conditions?" Steve continued.

"He gets migraines sometimes."

"Any medications for that?"

Jim shrugged. "Just over-the-counter stuff."

Steve nodded. "Any allergies?"

Jim paused, trying to remember any mention of such in all the years that he had known the Winchesters. "Not that I know of."

Steve nodded again as one of his colleagues interrupted.

"Temperature 103.3...heart rate 185 BPM...BP 80/50...O2 sat rate of 88%."

"Jesus," Steve quietly swore, turning away from Jim. "Okay, let's get an oxygen mask in place and then I want the EKG in here."

There was a scurry of activity as Steve leaned over Sam, cutting through his hoodie and exposing his chest. Jim gasped, closing his eyes briefly to block out the image.

Dark bruises covered Sam's chest and abdomen, marring the pale flesh in unsightly shades of blue. The ends leached to a soft gray, webbed with tiny red vessels that stretched outward. As his hoodie was completely removed, more bruises could be seen, covering his forearms and left shoulder.

"What the hell?" Steve whispered, once again loosing his grip on professional conduct. He exchanged glances with his fellow EMTs before directing his attention to Jim. "Has he been in an accident?"

Jim shook his head, too shocked to speak.

"A fight?"

"No. Nothing," Jim choked out. "He's been fine until this morning."

"Has he – "

There was movement on the floor, and all eyes turned toward it.

Sam stirred restlessly as he slowly opened his eyes. He didn't recognize any of the faces hovering over him and shivered as he became aware of the cool air on his bare skin. Although he was disoriented and confused, his mind seized on one word, on one name, on one person: _Dean_.

Sam didn't realize that he had actually spoken the name until he felt a familiar hand tenderly stroke his hair and then rest on his head.

"Dean..." he repeated.

Jim knelt beside Sam as the EMTs continued their assessment. "No, Sam. It's me."

Sam tried to focus on the face above him. "Pastor Jim?" He swallowed thickly. "Where's Dean?"

"Sam," Steve interrupted and waited for his patient to make eye contact. "My name is Steve, and I'm here to help you. Right now my buddies are going to hook up an EKG, so you're going to feel them pressing sticky pads to your chest. I need you to be a good boy and stay still, okay?"

"'Kay."

Jim smiled tenderly. Any other time and under any other circumstances, Sam would have bristled at being talked to as though he were a child, even though at 13-years old, he wasn't far removed from that description.

Steve nodded to his colleagues before directing another question to Sam. "Can you tell me how many fingers I'm holding up?"

Sam closed his eyes.

Steve looked at Jim and then back at his patient. "Sam? C'mon, kiddo, talk to me."

Sam sighed. _Kiddo._

The word seemed to soothe him but then suddenly his agitation increased.

_Dean_.

Where was he? He was always there when Sam needed him. Where was he now? He needed to see him. He needed him here.

For the first time since he regained consciousness, Sam tried to push himself up on his elbows.

Steve shook his head frantically. "No, Sam." He looked to Jim, his eyes questioning. Was he missing something? "You need to be still for us, remember? Be still, Sam."

"Where's Dean?" Sam rasped, his eyes searching beyond those around him.

"Shhh," Jim soothed. "It's okay, Sam. He'll be here later, okay?"

Sam stared up at the Pastor, his eyes filled with confused tears. "Later?"

Jim nodded. "Later. I promise."

"Who's Dean?"

"His brother," Jim said as he traded glances with Steve. "He's...out of town."

"Oh," Steve said simply. "Any other siblings?"

"No."

"His dad?"

"Also out of town."

"And his mom?"

Jim sighed, wondering why any of this mattered right now. "Deceased."

"Oh," Steve repeated, noticing his fellow EMTs starting over again with the set up of the EKG. "Sam, I didn't mean to upset you, but you need to be still while these guys hook up the EKG, okay? And I need you to answer my questions."

"Try."

Steve nodded and smiled. "Trying is good." He held up his finger. "Let's try this again: How many fingers am I holding up?"

"One."

"Good. Now, I want you to follow my finger with your eyes only. Don't move your head. Okay, good. Are you in any pain?"

Sam nodded weakly.

"Where?"

"Every...where."

Steve nodded. "Can you describe it for me? Is it burning, throbbing, aching, sharp, dull...what?"

Sam took so long to respond that Steve thought he had lost consciousness again. He rubbed his knuckles along his patient's sternum.

"Sam?" Steve prompted.

Sam hissed from the pain and violently flinched. "Please..."

"Stop," Jim ordered, glaring at the EMT as his hand protectively hovered over Sam's small chest.

Steve paused. "I'm sorry, Sam. I just need you to answer my questions. What kind of pain?"

"Don't know," Sam whispered. "Sharp...burning. Just h-hurts."

"On a scale of one to ten, with ten being the most pain, how much pain are you in?"

Sam swallowed, remembering Dean asking him the same question a few days ago.

"Where's Dean?" he asked, his voice hinting at tears.

Steve sighed and looked at Jim. "Was he this confused and disoriented before he collapsed?"

Jim frowned, surprised by his annoyance at the question. "He's not confused or disoriented. He just wants his brother." And if Steve knew Sam, he'd know they couldn't ask for a better sign of coherency. Jim swept Sam's bangs from his forehead. "Sam? One to ten, buddy."

"Ten."

Steve nodded, not surprised. His hands moved to palpate Sam's ribs and abdomen, pushing his fingers deeply into the bruised flesh, eliciting a moan from his patient.

"Enlarged spleen, some abdominal rigidity, possible hemorrhage..." Steve commented to himself. "Sam, can you tell me how you got all these bruises?"

Sam's breathing became ragged.

"Sam?" Steve persisted.

Sam's gaze shifted to Jim, tears filling his eyes.

Jim's heart stuttered. "What, Sam?"

"I'm sorry," Sam whispered, tears silently slipping down his cheeks.

An overwhelming sense of dread spread through Jim as he gently rubbed his thumb over Sam's forehead. "It's okay," he automatically soothed. "Just tell us..."

"Fell."

"You fell?" Steve clarified.

Sam nodded weakly.

"Fell?" Jim repeated, shaking his head slightly. Maybe Sam _was_ confused and disoriented. "No, Sam. You didn't fall, buddy."

Steve didn't seem to agree, immediately launching a new set of questions. "When? When did you fall, Sam?"

"Last n-night."

Steve nodded. "Where? What happened?"

"Tripped...on the stairs." Sam looked back at Jim. "I'm sorry."

Jim felt his heart drop as the pieces of this particular puzzle slid into place, beginning with him finding Sam sprawled on the mattress last night, borderline unresponsive as he had finished putting the kid to bed.

Steve opened his mouth to ask another question when one of the other EMTs called his attention to the EKG printout.

Jim carded his fingers through Sam's hair, trying to soothe his young charge, while his own heart slammed in his chest. The EMTs' hushed tones and grim expressions made his own breathing become shallow.

"Call ahead and tell them," Steve said as he turned back to Jim. "There's abnormal electrical activity in Sam's heart. It's beating entirely too fast and irregular, and since cardiac arrhythmias can lead to cardiac arrest, we're taking him to United."

"Of course," Jim responded, noticing that Sam had once again lost consciousness. He sighed and reluctantly moved back so that the EMTs could load Sam onto the stretcher.

"Oh...and his father and brother?" Steve asked, rising from the floor and looking directly at Jim.

Jim swallowed, fear clenching his gut as his eyes darted from Sam to Steve. "Yes?"

"I'd get them here."

_**TBC**_

_**Off to the hospital...which makes me happy 'cause Sam's never been in the hospital on the show. Dean's been three times; John's been; Bobby's been; even Cas has been. But Sam? Nope. Just there to visit or keep bedside vigil, which is so not fair. Just sayin'. **_


	8. Chapter 8

Dean sighed, the sound exceptionally loud in the eerie quiet of the library, and leaned forward in his chair, pushing back the stack of books and resting his elbows on the table. He covered his face with both hands, rubbing his eyes with his fingers before moving them laterally to massage his temples.

He was tired.

He was hungry.

And he was pissed.

He had been stuck in this shitty library doing research all day – hell, ever since he got to Ida Grove – while his dad was in Who-The-Fuck-Knows, USA.

Dean had arrived in Ida Grove on Wednesday, but by that evening, John had gotten a lead on another hunt a few towns over. Cleary frustrated and restless with the tedious nature of the current hunt, John had left, instructing Dean to continue to research in his absence, so they could get to work when he returned.

"I'll be in touch," John had promised early Thursday morning, before climbing into his truck and disappearing into the darkness.

Dean shook his head. After all his talk about backing each other up, John had just left...and Dean hadn't heard a word from his dad since.

_Typical John Winchester._

Dean sighed again.

When he had turned eighteen a few months ago, when John had given him the keys to the Impala, Dean thought that finally his dad would view him as an adult, as a partner whose input was not only desired but valued.

He was wrong.

His father still expected no-questions-asked obedience – stay here and research...period – and after the past few days, Dean was beginning to understand why Sam seemed to bristle at such an expectation: it was a pain in the ass.

_Speaking of pains in the ass..._

Dean smiled as his thoughts turned to his brother.

He was worried, as only big brothers could be, and still felt guilty about having to leave Sam – especially since his departure from Jim's was for nothing since John had bailed...again.

Dean had tried to call every night to check on his brother, but each night since Wednesday had yielded the same results: static on the line, followed by an ear-piercing beep and some woman's voice telling him the call could not be completed at this time...or apparently any other time.

Swearing had filled the air as Dean had ranted to the empty motel room after each failed attempt to connect with Jim...or more importantly, with Sam. He had assumed that the adage was true – that no news was good news – and knew that Jim would call if something was wrong with Sam, but still...

Dean shook his head and stared at the books in front of him. If he had known "researcher" would be his sole function – and solo function – in this hunt, he would have stayed at Jim's to keep an eye on his little brother and researched from there, relaying any pertinent information to John over the phone.

Dean snorted.

_Right. That would work well because Dad always answers my calls and returns my messages._

With that thought, Dean pulled his phone from the pocket of his leather jacket, not surprised that there were no missed calls from John. He knew that sometimes the signal sucked and didn't allow communication – as evidenced when he tried to call and check on Sam every night since Wednesday – but more often, his dad just used that as an excuse to be out of touch when he didn't want to talk.

Dean continued to stare at his phone, as if he could will it to ring, and was startled when it did just that. He blinked, focusing his eyes on the caller display.

"Pastor Jim?" he answered, ignoring the librarian's glare as she pointed to the "no cellular phones" sign.

"You need to come back here."

Jim wasted no time in pleasantries, and his voice was tight with tension, bringing Dean to his feet. "Why? What's wrong?"

"Sam's in Intensive Care."

"He's _what?_"

"Shhhh!" the librarian hissed, and Dean promptly flipped her off.

"In Intensive Care," Jim repeated slowly, as though he couldn't comprehend it either.

"What the hell?" Dean stood in stunned stillness as the librarian rounded the corner of her desk and headed in his direction. "What happened?"

There was silence.

"Jim!" Dean called loudly, wondering if the signal had been lost...and if the librarian knew what kind of shit would hit the fan if she tried to take the phone away from him. "What happened to Sam?"

Jim sighed. "I don't know."

"You don't know?" Dean repeated incredulously.

"Excuse me, sir."

Dean glared at the librarian as she stood at the head of the table.

"No cellular phones allowed," she declared, hands on her hips. "It's the rules."

"Yeah?" Dean asked, feigning interest as he lowered the phone. "Well, in that case...fuck you _and_ your rules."

The librarian gasped dramatically and spun around, stomping back toward her desk.

"Dean?"

"Yeah, I'm here," Dean responded, watching the librarian dial her own phone and then talk animatedly while glancing in his direction. "What's wrong with Sam?"

"Everything's wrong."

Dean could hear the shock in the Pastor's voice. "What the hell does that mean?"

"His heart rate is too fast. His blood pressure and oxygen levels are too low. Everything's just wrong."

"Shit..." Dean hissed, both at the information Jim had just relayed and at the two security guards that suddenly appeared around the corner.

"Dr. Collins says – "

"Dr. Collins?" Dean interrupted, yanking his leather jacket from the back of his chair.

"Sam's attending," Jim briefly explained. "He says that's why he collapsed."

"Collapsed?" Dean hesitated at the word and then disappeared between two bookshelves, lowering his voice. "When? Where?"

He ducked into the hall, glancing over his shoulder at the two security guards turning themselves in circles, as the librarian couldn't seem to make up her mind about which direction Dean had gone.

"Jim?"

"About an hour ago at the house."

Dean sighed, trying to keep it together as he continued down the hall. "How is he now?"

Jim paused. "He's stable right now, but he's still covered in bruises. On his stomach, his chest, his shoulders..."

"Bruises?" Dean yelled, digging in the right pocket of his jeans for the Impala's keys. "From what?"

More silence.

"Jim!" Dean burst through the library doors. "From what? What happened?"

"He fell."

Those two words made Dean instantly stop in the middle of the sidewalk, a dozen scenarios flashing through his mind but all ending with the same conclusion: _Sam fell...and I wasn't there to catch him. _

"Sonuvabitch!"

"Dean – "

"You were supposed to take care of him, Jim! Where the hell were you?" Dean lashed out.

"I'm sorry, Dean. I – "

"I told you not to leave him alone!"

"I know. I'm – "

"Then why did you leave him alone? Where were you?"

Jim sighed. "Bobby had stopped by the house, and I was outside with him when it happened."

"Where did he fall?"

"On the stairs. He was going back up last night after dinner and – "

"Last night?" Dean repeated. "Why didn't you call me then?"

"Because..."

Dean narrowed his eyes. "Because?"

"Because I didn't know last night."

Dean pressed his fist to his forehead, eyes shut, slowly walking in a tight circle as he willed himself to calm down. He could hear the regret and guilt in Jim's voice, and he couldn't blame the Pastor.

Sam could be a stubborn little shit, and as intrinsically good as Sam was, he was also becoming one hell of a liar. Withholding the entire truth with the right intentions for the wrong reasons tended to be Sam's forte these days – not to mention him being able to work the combo of those bangs and those eyes like nobody's business – so, Dean wasn't surprised that his little brother had managed to keep Jim clueless.

Seeing through Sam's bullshit and calling him on it was Dean's job.

Being there to catch Sam when he fell was Dean's job.

Taking care of Sam was Dean's job.

And John Winchester had taken him away from his job.

"I never should have left him."

"Dean – "

"I should've told Dad to shove this hunt up his ass!"

"Dean – "

"I never should have left him, Jim! Shit happens...especially to Sam...especially when I'm not around."

"Dean!"

Dean sighed harshly at the Pastor's raised voice and started walking towards the Impala. "So the bruises...they just indicate he got banged up or what?"

"We don't know yet. His spleen is enlarged, possibly ruptured, and they're suspecting internal bleeding along with – "

"Internal bleeding?" Dean interrupted.

_Fuck. _

"Nothing's conclusive yet," Jim placated.

"Why is his spleen enlarged?"

"We don't know. They've run a few blood panels, done an ultrasound, but they're going to wait at least until morning before they run all the other tests. He's barely stable, and they said doing anything else right now would be too much for him." There was another pause and then the Pastor's voice continued, laced with desperation. "Dean..."

Dean found himself standing beside the Impala and felt his jaw tighten against the emotion that suddenly surged through him. This was not happening. Not to Sam. Nothing could happen to Sam. He could handle anything but that.

"Which hospital?"

"United."

"I'm on my way." Dean opened the driver's side door and slid behind the wheel. "Wait...do they know about – "

"It hasn't been mentioned," Jim assured, knowing Dean was concerned about the insurance situation encountered during Sam's surgery. "Besides, Sam's admitted under 'Sam Murphy' this time, and he's on my insurance. Everything's taken care of on that front."

"Jim, we can't – "

"Shut up, Dean."

Dean did as he was told, simultaneously surprised and amused by the Pastor's blunt response and uncharacteristic terseness...and also immensely grateful for what he had done. They didn't have many friends, but the ones they did have were more like family.

"Quality trumps quantity," John had once remarked, and Dean agreed.

"Does Dad know?" Dean asked as he cranked the Impala.

"He didn't answer his phone, so I called you."

Dean snorted. _Story of my life..._

"Yeah, well…" Dean's voice trailed off as he pulled into the street. "I have no idea where he is, but I'll call him, too."

"Wait," Jim said, his tone confused, then annoyed. "What do you mean you have no idea where he is? Aren't you two hunting together?"

"Not since Thursday morning. He got a lead in another town and headed out."

"Where was he going?"

"Hell if I know..."

"He didn't say?"

"No. Just got the lead and left, heading north."

"Have you heard from him?"

"What do you think?" Dean asked sarcastically.

There was silence on the other end of the line, and Dean wondered, not for the first time, if Jim ever silently swore. If anyone could make him do it, it would be the Winchesters.

"I'll call Bobby," Jim stated, as though the decision was already made. "Get him to track down your father."

Now it was Dean's turn to be silent. The plan of putting Bobby on John's trail confirmed what he already knew despite Jim's previous efforts to placate: this was Sam-might-not-make-it serious.

_Fuck._

He needed to hear his little brother's voice.

"Is Sam awake?"

"No. He hasn't been awake since we left the house."

Dean swallowed, his grip tightening on the steering wheel. "Well, if he wakes up before I get there, tell him – "

"I'll tell him you're on the way," Jim interrupted. "He kept asking for you earlier, so that should make him happy."

The Pastor chuckled softly, sadly, and Dean felt tears sting his eyes.

The rumble of the Impala filled the silence before Dean cleared his throat. "I'll, um..." He cleared his throat again. "I'll see you soon," he said hoarsely, ending the call and pushing harder on the gas pedal.

**_TBC_**


	9. Chapter 9

Voices whispered around Sam, the words buried beneath a fog of medication. The tones sounded distorted – sometimes clear and close, sometimes far and faded – but always with him, hovering in the distance, pressing ever closer to his consciousness until he could no longer ignore them.

The darkness lifted from within as sensation slowly returned. Sam forced his eyes open and felt a hand on his forehead, sweeping his hair from his eyes. He tried to focus on the blurry image above him.

"D'n..."

"Shhh..."

Sam blinked.

"It's alright, Sam."

"Jim?"

"Mm-hmm..."

"Dean..."

"He's coming," Jim soothed.

Sam seemed to consider that promise as he swallowed with difficulty and slowly became more aware. He felt the invading pressure of a Foley catheter, the pinch of an IV; the tubing of a nasal cannula wrapped around his ears, stretching across his cheeks and up his nose, and there was some kind of clip on his finger that didn't hurt but was uncomfortable. There were wires coming from his chest and attached to monitors beside the bed, and then there was that unmistakable smell...

_Hospital_, Sam thought as his eyes dipped closed.

He opened his eyes again and turned his head toward the window to his right. It was dark outside and dark in the room, and he knew it must be late. Was that why he was so tired – or was it the cadence of the beeps the monitors kept producing that was lulling him to sleep?

Sam turned his attention back to the Pastor as he tried to change positions in the bed. A sharp pain emanated from his chest and abdomen, causing him to catch his breath harshly.

Jim frowned. "Sam? What's wrong?"

"Hurts..." Sam managed through shallow breaths.

Jim scanned Sam's body with his eyes. "Where?"

Sam's arms began to protectively encircle his midsection, giving Jim his answer.

"Do you want me to call the nurse?"

Sam shook his head.

"Sam, if you're in pain, then we need to let the nurse know," Jim explained reasonably.

Sam shook his head again.

"Sam..."

Sam continued to shake his head.

"Okay..." Jim relented, sighing and feeling his nerves begin to fray. He wasn't used to dealing with this version of Sam, and he hated feeling this helpless. "What do you want then?"

Sam stared at him.

"Sam?" Jim prompted, not wanting to but yet feeling a little annoyed; stress would do that. "What do you want?"

Sam's eyes were suddenly rimmed with tears. "Dean."

Jim softened immediately at the whispered name, wondering if Dean knew just how much this kid loved him. "He's on his way."

Sam held the Pastor's gaze and then slowly turned over his hand as it rested beside him on the mattress. "Promise?"

Jim smiled tenderly, reminded by that simple, trusting gesture that for all of Sam's intelligence and training and maturity beyond his years, he was still just a child; a sick child who only wanted the one person that always made things better.

Jim grasped the kid's small hand and squeezed it lightly. "I promise, Sam. Dean is on his way."

"'Kay," Sam responded, sniffling as his breath hitched on a sigh. He returned the pressure to Jim's hand and closed his eyes.

A soft smile continued to linger on the Pastor's face as he sighed in the silence that settled between them.

"Sam, do you want me to – "

Sam squeezed his hand again, effectively interrupting him, and then opened his eyes.

"What, Sam?" Jim leaned closer. "What is it?"

Sam blinked, trying to focus. "Sick?"

Jim's eyes widened. "You're going to be sick?"

Sam shook his head weakly, pointing to himself.

Jim stared at Sam.

Sam stared back.

"Sick?" Sam asked again.

Jim shook his head, wishing Dean were there to translate. He always made this look so easy. "Sam, I don't – "

Sam inhaled deeply, noisily. "Am I..."

"What, Sam?" Jim interrupted, leaning even closer, anxious to know.

"...sick again?"

Jim sighed, feeling embarrassingly dense. Of course that's what Sam was asking...

"Yes," Jim answered simply. "You are, buddy."

"What's..." Sam swallowed and winced. "What's wrong?"

"We're, um..." Jim smoothed the blanket over Sam's chest and then patted the hand he still grasped. "We're not sure yet."

"Am I..." Sam hesitated, glancing down and then looking directly at Jim. "Am I gonna be okay?"

The Pastor's heart constricted at the simple question.

_I don't know_, he silently confessed. _But I don't have a good feeling about it._

Jim forced a smile, realizing he had taken too long to answer and that Sam knew the implications.

Tears glistened in Sam's eyes as he sank back into the bank of soft pillows and averted his gaze.

"Sam..."

Sam closed his eyes at the sound of his name and felt warm tears slip through his lashes. "Where's Dean?"

Jim smiled affectionately, thumbing the moisture from Sam's cheeks where it dammed along the tubing of the nasal cannula. If he had a nickel for every time Sam had asked him that...

"He's coming, Sam."

"I wanna..." Sam seemed to choke on his tears. "I wanna...see him." He looked up at Jim. "I want him here."

"I know," Jim soothed, wondering if Sam knew he was breaking his heart. "He's on his way."

"Soon?"

Jim nodded, brushing his fingertips across Sam's forehead, sweeping the fringe of bangs from the kid's eyes. "Soon."

Sam returned the nod, sighing as he closed his eyes again, exhausted.

_Soon_. _Dean will be here soon._

It was the last thought to cross Sam's mind before he allowed the heavy pull of sleep to take him.

* * *

Hands touched him, probing, examining, causing intense pain. In the gray fog that encased his mind, Sam heard the sound of disjointed voices, fragments of words floating beyond his awareness or his ability to understand, to react.

"...extremely pale...his blood pressure...oxygen levels...still too low...heart rate...still too high...adjust meds...watch him closely."

Jim leaned forward placing his hand on Sam's forehead, feeling the heat burning inside the youngest Winchester. "His fever is up."

"I know," Dr. Collins commented as he wrote in Sam's chart. "It seems he may have an infection on top of everything else. Were antibiotics prescribed after his tonsillectomy?"

Jim nodded. "Yes, but – "

"Let me guess," Dr. Collins interrupted. "He wasn't consistent in taking them."

Jim nodded again, knowing it would've been different if Dean had been around. Sam would've taken the pills, whether he liked it or not. Period.

"That's typical. Patients don't want to eat or drink, much less swallow pills, after their tonsils are removed. Especially children. I'm surprised he didn't get liquid antibiotics."

_Beggars can't be choosers,_ Jim thought sadly as his hand rested on Sam's thin, bruised arm, remembering the brown paper bag of medicine samples.

"Let's see..." Dr. Collins flipped through the chart. "Okay. Looks like the ultrasound confirmed a small tear in Sam's spleen, which would be consistent with his fall on the stairs last night. And since the spleen is a highly vascular organ, any kind of blunt trauma to the left upper quadrant of the abdomen can result in hemorrhaging, especially when it's enlarged, as Sam's is and mostly likely has been for the past few days, if not weeks." He glanced up at Jim. "Were you aware his spleen was enlarged?"

Jim remained silent, shaking his head as he stared at Sam.

"Huh. We'll need to find out more about that..." Dr. Collins commented to himself, making more notes in the chart. "Anyway...in years past, we would be discussing an emergency splenectomy right now, but things have changed."

"How so?" Jim asked, hoping this would lead to good news.

Dr. Collins tucked the folder under his arm and crossed to the bed. "Medical science has learned that the spleen plays a key role in immunity, so the preferred treatment is allowing the spleen to heal on its own whenever possible to preserve it. That's why we're keeping Sam sedated and flat on his back. Sometimes in lying flat, the spleen will clot and heal itself – which means we would avoid another surgery." Dr. Collins folded back the blanket across Sam's lap before pulling aside his gown, eyes expertly scanning the kid's torso. "But..."

Jim narrowed his eyes. "But what?"

"Well, it's been a few hours and the bruising patterns indicate that his blood is still not clotting properly."

Jim shifted his gaze to the doctor, not liking his concerned tone. "So Sam's spleen isn't healing itself as it should?"

Dr. Collins shrugged. "Hard to say. We'll wait and see how he does overnight, but in some cases, surgical repair – referred to as splenorrhaphy – may be required and is typically adequate to stem bleeding and preserve the spleen, thus protecting the patient's ability to fight infection. Our primary concern right now, though, is keeping Sam stable. Given the approximate time of his fall last night, he's been bleeding internally for close to 24 hours."

Jim felt a stab of guilt. How could he not have noticed, not have known?

"Fortunately," Dr. Collins continued, "the hemorrhage wasn't massive, but he's still in a state of hypovolemic shock due to the blood loss he's gradually sustained. Monitoring his vitals is crucial at this point. His breathing is shallow and rapid because he's not getting enough oxygen in his blood and that is causing his heart rate to be erratic. Plus, his heart was already having difficulty in pumping blood to his body due to inadequate blood volume, which could result in multiple organ failure if we don't get a handle on this situation."

"Organ failure?" Jim repeated, unsure if he was going to scream, cry, or throw up.

"It's a possibility," Dr. Collins confirmed. "But Sam seems like a strong kid, a fighter, so I'm not counting him out just yet." He smiled encouragingly. "Has he been awake?"

"About an hour ago, but only for a few minutes."

"That's typical, given his level of sedation."

Jim nodded, still trying to comprehend all the information. "He said he was in pain. Shouldn't the drugs take care of that?"

"Yes, but we may need to increase his dosage. The pain is coming from the ruptured spleen and the bleeding that's beginning to seep into his joints. Immobility is the best thing to prevent any further bleeding and lessen the pain; unfortunately, immobility is detrimental to his low circulation. Because he doesn't have the proper blood quantity, his circulation is poor, which advocates blood pooling. One thing leads to another, and it becomes a vicious cycle. I'm going to order physical therapy twice a day to help keep the blood circulating."

Jim watched as the doctor began to write in the chart again. "Physical therapy?"

"Yes," Dr. Collins said, closing the chart and giving it to the nurse who had been dutifully standing nearby. The door closed softly behind her as she left the room and the doctor continued. "They won't get him out of bed, of course, but they'll do light massages and different exercises to keep his blood circulating."

Jim nodded.

"Also, he's not producing red blood cells at a satisfactory rate, and we need to find out why he's so severely anemic. The blood loss is, of course, a contributor, but I suspect something else. It could be as simple as a vitamin deficiency, given Sam hasn't been eating properly, but it could also be..." His voice trailed off and he paused. "Pastor Murphy, as Sam's uncle, do you know if there is a family history of cancer?"

"No," Jim answered, uneasy at the sudden change of topic and at the mention of that word. "Why?"

Dr. Collins chewed on the inside corner of his mouth, hesitant to share his thoughts. Relaying suspected diagnoses to patients and their families based solely on a gut feeling was frowned upon; such information needed to be backed by test results, by scientific evidence.

Jim sensed the doctor's unease and felt his own heart rate increase. "_Why?_" he asked again, worry and fear making his tone harsh.

"Well," Dr. Collins sighed, "we won't know for sure until the test results come back, but his symptoms are indicative of ALL – acute lymphocytic leukemia."

"Leu..."Jim's voice faltered.

"Yes, leukemia," Dr. Collins nodded. "This particular type is most common in children, and progresses quickly if it is not treated."

Jim shook his head, refusing to believe. "But he's been fine..."

"Sometimes this condition can present with little to no warning." Dr. Collins paused, trying to remember without retrieving the chart. "He has a brother, correct?"

Jim nodded.

"Good. If this turns out to be ALL – and if we need to perform a bone marrow transplant – his brother would be the best source for a match. He would be willing, yes?"

Jim cut his eyes to the doctor, offended that he would question Dean's love, his commitment to his brother. "Dean would do anything for Sam."

"That's good to hear." Dr. Collins held Jim's stare, sensing he had unintentionally caused an affront. "But we're getting ahead of ourselves. Before we start thinking about treatment, we'll need to run more tests to confirm an actual diagnosis. I've ordered a peripheral blood smear and a cytogenetic analysis, and those results should be back in a few hours."

"And then what?"

"Well, depending on those results, we may need to do a bone marrow aspiration and biopsy tomorrow to confirm and officially diagnose. But all of his symptoms – weakness, fever, bruising, shortness of breath, pain below the ribs and in his joints, even the enlarged lymph nodes in his neck that may have been misdiagnosed and resulted in the tonsillectomy, along with the enlarged spleen that ruptured – everything points to ALL."

Jim glanced at Sam, then back at the doctor, speechless.

"I know it's a lot to absorb." The doctor smiled sympathetically. "I'll be back later with the results, and in the morning, we'll begin running our other tests. Hopefully we'll know for sure what we're dealing with in the next 24 hours. In the meantime, try to get some rest. This could be a long road."

"Okay," Jim said simply, not knowing what else to say. It was all so overwhelming.

Dr. Collins nodded, understanding Jim's loss for words, and left the room, allowing the door to close quietly behind him.

As the minutes clicked by, as the silence began to impose its own brand of solitude, Jim stood beside Sam's bed, lost in his thoughts. He gazed down at John's youngest son, mentally reviewing all the information he had just received and slowly shook his head. Hope was sometimes so delicate, and it was amazing how quickly panic and despair could set in; it was more amazing still how quickly both could lead to grief.

Jim eased down into the chair beside the bed as he closed his eyes and bowed his head, sighing. Remembrance, like a candle, burned brightest at night – and he remembered this feeling, had felt it and shared it with friends and parishioners throughout the years: a devastating combination of concern and anger, hopelessness and sorrow, denial and regret.

Jim lifted his head and continued to stare at Sam.

_He doesn't deserve this._

Jim felt tears sting his eyes then slip silently down his cheeks as he realized the irony. People tended to live under the impression that they always got what they deserved – and life didn't work like that. Experience was often a cruel but accurate teacher, and every hunter had learned the lesson well. Life had a well-founded urgency. Time slipped; days passed; years faded; and life ended. Time was all you had – and then one day you realized you had less than you thought.

Jim drew a shuddering breath and shook himself, suddenly standing.

_I'm not going to do this_, he thought as he wiped his eyes and straightened his shoulders, seeming to draw on determination he knew he would need.

"Don't worry, Sam." Jim approached the bed once more, stroking Sam's fever-damp hair. "I'm going to be strong for you," he whispered and then suddenly thought of Dean...and of John and Bobby. Jim smiled and continued to card his fingers through Sam's hair. "_We_ are going to be strong for you."

* * *

A little over two hours had passed by the time he arrived.

"How is he?"

The uncharacteristically soft words drifted into the stillness of the room, startling Jim as he rose stiffly from the chair, his body fatigued from sitting in one position for so long.

The Pastor approached Bobby as he stood by the door but said nothing as he looked at his fellow hunter and then back to their friend's youngest son, motionless in the bed.

Although he knew that silence was an easy text to misread, Bobby couldn't help the unease that rose in his chest as he followed Jim's gaze to Sam.

_I just saw him...and he was fine_, he thought as he took in the IV lines, the wires, the monitors.

It had been the same thing he had said when Jim had called earlier that evening. He had answered his cell phone on the second ring, seeing the Pastor's name on the caller display.

"Make it quick, I'm busy," he had said gruffly, phone pressed to his ear by his shoulder and held in place by his chin as he hoisted an ammo crate into his truck bed.

"I need you to find John."

"Why? What's shit-for-brains done now?" Bobby had asked distractedly, pushing the crate back and slamming the tailgate. The answering silence had made him pause. "Jim?" he had prompted.

"Sam's sick," Jim had said, his voice tight. "He's in the Intensive Care Unit here at United."

"He's what?"

"Dean's on his way," Jim had continued as though Bobby hadn't spoken. "But we don't know where John is...and he _needs_ to be here."

Bobby had felt his stomach drop at the implication of those words, at the determined desperation in that tone: this was serious – life or death serious.

"But I just saw Sam last night," Bobby had responded. "I just saw him, and he was fine."

_He was fine_, Bobby's mind repeated as his thoughts faded and his attention again rested on Sam, who was clearly not fine anymore. He swallowed with difficulty; a knot of emotion suddenly lodged in his throat.

"I didn't expect you to come by," Jim commented.

Bobby shrugged. "Just wanted," – _needed_ – "to check on things..." _– on him._

Jim nodded, understanding without further explanation. John's sons didn't just belong to John. The boys were _their_ boys, too.

"So...how is he?" Bobby asked again, aware that his question had been dodged earlier, and was horrified to see tears spring to the Pastor's eyes.

Jim took a shuddering breath, determined to keep control.

"Jim – "

"They think he has leukemia," Jim blurted, the words spilling out in a rush as though saying them faster, as though sharing them, would ease the pain they caused.

"They..." Bobby began and then stopped abruptly as his voice wavered. "Ah, shit." He breathed deeply. "Are they sure?"

Jim shook his head. "Not yet," he responded, looking back at Sam. "We should know more later tonight."

Bobby once again followed Jim's gaze to Sam and then looked away. It was too much; he had seen a lot of messed up shit, but he couldn't bear to see the kid like that. It was strange and disconcerting for Sam not to be bouncing around, full of energy and questions and explanations that no one understood. He was so pale, so still. He looked like he was...

_But he's not, you damned idjit,_ he chastised himself, closing his eyes briefly. _Jesus. Pull it together, Singer._

He sighed. "Have you heard from Dean?"

Jim nodded. "He's been calling about every ten minutes."

"What's his 20?"

"He's about half an hour away."

There was silence.

"Does he know?"

More silence.

Jim slowly shook his head.

Bobby nodded, understanding Jim's decision to not relay such news over the phone and not envying the Pastor's task of telling Dean once he arrived.

"So..." he sighed. "Tell me about J.W."

Jim surprised himself with a smile and a chuckle. John hated it when Bobby called him that. "He was in Ida Grove until Thursday morning, when Dean said he left the motel, heading north. No one has heard from him since, and he's apparently not in the mood to return messages."

Bobby snorted but said nothing, absorbing the information as his skill and instinct began to map out a plan. He crossed to the bed, staring down at John's youngest as he slept, before grasping the kid's unnervingly cold hand and gently tousling his hair.

"If your daddy is still in one piece when I find him, I'm gonna kick his ass."

"And I might help," Jim added, also crossing to Sam's bedside and smiling when Bobby arched an eyebrow.

"I'd like to see that." Bobby chuckled. "Wouldn't you, Sam?"

"Better get moving then, before the offer expires," Jim advised, thankful for the momentary lightness.

A smile lingered on Bobby's lips as he nodded, squeezing Sam's hand and patting Jim's shoulder before turning towards the door.

**_TBC_**


	10. Chapter 10

Dean stood in the doorway of Sam's room and knew why he had heard tears in Jim's voice when he had called the Pastor earlier to check on his brother.

"He's...um..." Jim's voice had trailed off, words failing him.

Dean's grip had tightened on the phone, fear clenching his heart and making his tone a little too rough. "Jim..."

"He needs you," Jim had said simply.

_He needs you. _

Jim's words echoed in Dean's mind as he quietly stepped into the room, fear filling his heart as he gazed at his little brother.

Sam was surrounded by a tangle of wires that led to monitors and IV lines attached to various bags hanging nearby. He was motionless and looked uncharacteristically small and fragile, and although there was a slight flush coloring his cheeks, the paleness lingered beneath the mauve bruises under his eyes. He didn't move as Jim smoothed the blanket over his chest.

Dean's gaze fixed on the Pastor. Jim's face was etched with concern, his eyes dark and intense, his body drawn and fatigued. The endless worry and constant care over the past several hours was draining his strength.

"Jim..." he said quietly.

Jim turned, relief flooding his features when he saw Dean standing there, a sad smile playing on his lips as he moved toward the door. "I'm so glad you're here," he whispered, his voice betraying his exhaustion and relief as he hugged John's oldest.

Dean said nothing as he stared over Jim's shoulder at the still form of his brother. The Pastor had always been more demonstrative when it came to emotions than the Winchesters, but hugging him upon his arrival? That couldn't be good...

Dean pulled back, sharing a look with Jim before approaching Sam's bed. His hand swept damp bangs aside before resting on his brother's forehead, his fingers cool against the fevered skin.

"He's been asking for you, Dean."

Dean nodded and found it difficult to speak around the knot of emotion that rested in his chest, in his throat. "I'm here now, Sammy," he whispered, leaning close to his brother, forehead against forehead, hoping Sam could hear him. He stayed that way for a moment before straightening, his eyes never leaving his brother's face. "How is he?"

_He's slipping away_, Jim silently answered. _He's slipping away, and there's nothing we can do about it._

When no answer came, Dean looked over his shoulder at the Pastor, still standing by the door. Jim's eyes were suddenly rimmed with tears, and Dean felt his heart drop.

"Jim?"

"They're running tests," Jim managed.

Dean nodded, a sense of dread growing. "For?"

Tears slipped from Jim's eyes.

Dean felt his heart slam in his chest. "Jim..."

"They think it might be leukemia."

Dean visibly swayed, momentarily speechless in stunned disbelief. "What?"

"Leukemia," Dr. Collins repeated coming through the door in a rush, clutching Sam's chart. "But test results indicate that he doesn't have it. We ran it twice, and there were no abnormal lymphocyte blasts present in his blood."

Jim closed his eyes briefly, thankful and yet not relieved. If not that, then what? Something was clearly causing Sam's health – and perhaps his life – to ebb away from him.

"You must be the brother," Dr. Collins said coming further into the room, extending his hand. "I'm Dr. Collins, Sam's attending."

Dean continued to stare at the doctor, not interested in introductions. "Dude, what the fuck?"

"Dean – "

"No, Jim," Dean interrupted, worry and fear mixing to combustible anger as he approached the doctor, the intensity of his emotions making his expression unreadable.

Jim moved forward as well, poised to intervene if this confrontation turned physical. This was Dean, after all, and Hell had no fury like a Dean protecting his Sammy.

Jim sighed, trying again. "Dean – "

Dean ignored him. "You scare the shit out of us, talking about leukemia – and then you fly in here like some kind of fuckin' hero and tell us 'never mind'? I mean...what the fuck?"

Dr. Collins nodded. "You're right. I'm sorry."

"You're sorry? Well, whoop-de-fuckin'-do..." Dean growled, his voice echoing into the hall.

There was a moment of awkward silence filled with Dean's harsh breathing before the doctor's pager went off.

"I'll be right back," Dr. Collins said, taking the pager from his belt and stepping into the hall.

"What a fuckin' dumbass..." Dean muttered as he ran his hand over his face and sighed, trying to calm his enflamed temper. He looked at Jim and sighed again at the expression on the Pastor's face. "What?"

Jim shrugged. "I don't even know where to begin."

Anger ignited in Dean's eyes once again as he approached Jim, hand alternately pointing at the Pastor and then in the direction the doctor had gone. "Jim, he should have never said anything to you about leukemia or anything else until he had the test results back." Dean shook his head, disgusted. "He should have kept his mouth shut until he _knew._ It pisses me off that he worried you like that for nothing."

"And you," Jim added, casting a glance in Dean's direction, knowing from experience how John's oldest handled emotions. For Dean, it was often easier to be angry than scared.

Dean said nothing, remembering the feeling of immediate, overwhelming fear that had seized his heart at the mention of that word.

_Leukemia._

_Fuck. _

Dean shook his head again, snatching off his leather jacket and flinging it to the nearby chair. He felt his rage dissipate as he moved to stand beside Sam's bed, eyes scanning the monitors before focusing on his little brother and gently squeezing the kid's limp hand.

"It's okay, Sammy," he whispered, knowing Sam was asleep – and had been asleep the entire time – but still unable to stop himself from soothing a little brother that had always been easily upset by verbal altercations.

Jim still stood in the middle of the room, watching Dean and swallowing against the lump in his throat, then startling as the doctor reentered the room behind him.

"Sorry about that," Dr. Collins apologized, still holding Sam's chart.

Dean turned abruptly and faced the doctor, his expression instantly changing. "So, now what?"

Dr. Collins sighed as he leafed through the chart, studying the electrolyte panel. "Now we run more tests." He paused and then looked up. "I'm particularly concerned about his potassium levels; they're dangerously elevated."

"Why is that a concern?" Jim asked.

"Potassium is one of the electrolytes that can affect heart rhythm. In fact, extreme degrees of hyperkalemia – "

" – hyper...what?" Dean interrupted, lingering annoyance making his tone harsh.

"Hyperkalemia," Dr. Collins repeated and then explained. "It's a condition caused by abnormally high levels of potassium in the blood. Extreme degrees of it are considered a medical emergency due to the risk of potentially fatal arrhythmias." Dr. Collins paused, thinking. "In retrospect, his elevated potassium levels may have contributed to his initial collapse."

Jim shook his head, confused. "I thought the ruptured spleen and resulting blood loss caused Sam to collapse?"

"Correct. But hyperkalemia may have exacerbated his symptoms."

Dean took a step toward the doctor, as if being closer would increase his comprehension. "What makes you say that?"

"Well, hyperkalemia can cause fatigue, weakness, difficulty breathing, muscle and joint pain, a drop in blood pressure, decreased oxygen saturation, an irregular heartbeat..."

Jim exchanged glances with Dean. "What would cause this condition?"

Dr. Collins directed his attention back to the Pastor. "Most commonly it can be caused by ingesting large amounts of potassium, but that seems unlikely in Sam's case since he doesn't take potassium supplements...does he?"

"No," Dean answered immediately. "The only thing Sam has ingested large amounts of over the past week is – "

"...is apple juice," Jim finished.

"Huh."

Two pairs of eyes focused on the doctor.

"'Huh' what?" Dean asked, his tone sharp.

"Apple juice is moderately high in potassium – having anywhere from 125 to 225mg per serving – and if he's consumed large amounts of it..." Dr. Collins shrugged.

"Wait..." Dean shook his head. "You're saying Sam OD'ed on apple juice?"

Dr. Collins swallowed a laugh. "No. Well...I suppose it's possible but certainly not likely."

"So what _is_ causing it?" Jim asked, hearing irritation slip into his tone.

"Hard to say. Hyperkalemia can be caused by several conditions, but in Sam's case, I think we'd be best served to consider the destruction of red blood cells due to severe injury as the cause."

"So, the rupture of his spleen caused this hyper...whatever?" Dean waved his hand as if it would help him remember how to pronounce the word.

"Yes, I think it certainly contributed to it. But the condition can also be indicative of improper kidney function – specifically the inability of the kidneys to excrete potassium, which is hallmark to acute renal failure – or impairment of the mechanisms that move potassium from the circulation into the cells...or a combination of these factors."

"Wait. Renal failure?" Dean asked, hoping he had heard wrong.

Dr. Collins nodded. "Yes, unfortunately."

Dean returned the nod. _Fuck._

"So, now what?"

Dr. Collins glanced at Jim and began writing in the chart. "I'm ordering another electrolyte panel to measure the potassium levels again. Sometimes the initial elevation can be due to hemolysis in the first sample."

Jim shook his head. "Hemolysis?"

The doctor looked up briefly. "It's the breaking open of red blood cells and the subsequent release of hemoglobin into the surrounding fluid which can cause an inaccurate measurement of potassium..." His voice trailed off at the look of bewilderment on Dean's face. He smiled. "Research it."

"Yeah," Dean said, glancing at his little brother. _Sam would love __that._

"Anyway," Dr. Collins continued, beginning to write in the chart again. "I'm also ordering blood tests for renal function as well as a renal ultrasound."

"So now our primary concern is Sam's kidneys?" Jim asked, his brows drawing together.

"Well, we need to determine their level of functioning in order to properly diagnose and treat, especially since hyperkalemia is highly suggestive of renal failure. And of course, in the midst of all this, we can't forget about his ruptured spleen and the resulting hypovolemic shock." Dr. Collins checked the monitors before continuing. "Sam's blood pressure and O2 sats...both are still dangerously low. His heart rate has dropped as well."

"But that's good, right?" Jim sought to clarify. "It was too fast before."

"It was," Dr. Collins agreed. "But now it's dangerously low. I'll order an EKG. "

"They did one at the house earlier," Jim informed, not wanting Sam to endure any more tests and procedures than necessary.

"Yes, I know. But Sam's status has changed." The doctor crossed to the bed and began to palpate Sam's abdomen.

"Don't hurt him," Dean warned, knowing it was unnecessary but unable to stop himself.

Dr. Collins smiled softly. "I won't."

Dean crossed to the other side of the bed, his hand resting on Sam's arm as he watched the doctor closely. "What are you checking?"

"His spleen, which, unfortunately, is working against itself."

"Meaning?" Dean asked, arching his eyebrow.

Dr. Collins sighed, rearranging the blanket and stepping away from the bed. "When the spleen enlarges, it traps and stores an excessive amount of blood cells and platelets, thereby reducing the number of blood cells and platelets in the bloodstream. This process creates a vicious cycle: the more cells and platelets the spleen traps, the larger it grows; the larger it grows, the more cells and platelets it traps. Eventually, the greatly enlarged spleen also traps normal red blood cells, destroying them along with the abnormal ones."

"Okay." Dean glanced at Jim. "So..."

"So," Dr. Collins repeated, "given this situation, it's highly likely that Sam's red blood cell count was dangerously low prior to his fall because of his enlarged spleen and has only been exacerbated by the rupture of his spleen and subsequent hemorrhage."

"But you said earlier that if Sam was kept still, his spleen should clot and heal itself, right?" Jim asked.

"Theoretically, yes," Dr. Collins agreed. "I've had several patients over the past few years that responded well to that plan of treatment, but then sometimes..."

"Sometimes?" Dean and Jim asked together.

"Sometimes excessive numbers of blood cells and platelets can clog the spleen, interfering with its functioning – and its healing of itself – and there have been cases when an enlarged spleen actually outgrows its own blood supply."

"Jesus," Dean whispered, his grip tightening around Sam's arm.

"That scenario would, of course, be especially devastating to Sam's system since his blood supply is already alarmingly low due to the hemorrhage," Dr. Collins continued. "And while an enlarged spleen is not a disease in itself, it _is_ the result of an underlying disorder."

Dean sighed. "Like this hyper... "

" – kalemia," Jim finished, glancing at Dean.

Dr. Collins shook his head. "No, we don't typically see an enlarged spleen with hyperkalemia – but then every patient is unique in what symptoms he or she presents. In my 20 years of practicing medicine, I've learned to 'never say never.'" He shrugged. "One of the most well-known and common causes of an enlarged spleen is, of course, mononucleosis, but I'm sure that was ruled out prior to Sam's tonsillectomy, so I think – "

"No, it wasn't," Dean corrected, suddenly uneasy. "The doctor at the clinic didn't do any tests. I even asked the prick if he needed to, but he assured me Sam had strep and needed surgery immediately."

Dr. Collins narrowed his eyes. "He diagnosed strep without doing a strep test?"

Dean nodded, wishing he _had_ punched that doctor in the face.

"Unbelievable. What a dickhead..." Dr. Collins snorted and then immediately caught himself. "I mean – "

"No," Dean interrupted. "You got it right the first time. He was definitely a dickhead."

"Gentlemen..."

"Sorry, Jim." Dean glanced at the Pastor, then back at the doctor. "Sam did have the white patches in his throat, though, just like he usually does when it's strep."

"Yes, but sometimes patients with mono can present with a white film on their tonsils that resembles the patches...or on rare occasions, strep can occur along with mono. That's why it's crucial to test, especially before recommending surgery. And we usually allow the patient to get well before performing the procedure." Dr. Collins shook his head, clearly disgusted.

Jim sighed. "So, now you're thinking mono?"

"No, I'm not thinking it; I'm diagnosing it. We'll run a monospot test to be sure, but Sam's white blood cell counts were elevated enough to indicate mono. But since I assumed mono had been ruled out prior to his surgery a few days ago, I just thought the increased levels pointed to Sam's post-op infection. But mono explains all of his original symptoms – fever, fatigue, weakness, sore throat accompanied by swollen lymph nodes and tonsils...and an enlarged spleen."

"An enlarged spleen that none of us knew about," Jim commented.

"Exactly," Dr. Collins agreed.

"Well, even though I'm pissed this wasn't caught sooner – and _beyond pissed_ that Sam had surgery he didn't need – this is good news, right? Mono is easy to treat."

Dr. Collins shook his head at Dean. "If Sam had been diagnosed correctly four days ago, then yes...treatment would've been relatively easy – just rest, plenty of fluids, and avoidance of physical activities to protect his spleen. Unfortunately, the situation is much more serious now. Sam's spleen has ruptured, and I'm concerned we're bordering on life-threatening blood loss at this point, especially considering his other organs – like his kidneys – are showing signs of possible failure."

"What about a blood transfusion?" Jim asked, not caring how desperate he sounded.

"Not an option right now. He's not stable enough."

"Then do the surgery," Jim countered.

"Also not an option at this point for the same reason."

"Then what _are_ our options?" Dean snapped.

"We continue to monitor him over the next few hours. We monitor his vitals as well as urine output, and we see if the meds I've prescribed raise his blood pressure and cardiac output. That's all we can do right now."

There was a moment of silence as Jim and Dean stared at each other, overwhelmed with information and anxiety.

"Well..." Dr. Collins glanced at the clock. "It's getting late, and I have a few more patients to see. We'll begin running those tests in the morning." He turned toward the door. "Good night."

"Good night," Jim returned as he sank into the nearest chair, listening to the doctor's footsteps fade down the hall.

"Ah, Sammy..." Dean sighed, carefully adjusting the nasal cannula's tubing over his brother's ear as he brushed back Sam's hair. "What are we gonna do now, kiddo..."

Jim's gaze shifted from the door to Dean. "We should pray."

"For what reason?" Dean asked sharply. "To hear ourselves talk?"

"Sam believes in prayer," Jim reminded. "He would agree with me on this."

"Sam also believes in unicorns."

"Dean, this is serious."

"Do you think I don't know that?" Dean asked, glaring at the Pastor. "Sam was misdiagnosed on _my_ watch."

"You didn't know."

"He had surgery he didn't even need because of _my_ decision."

"A decision you based on a doctor's recommendation, Dean." Jim paused, knowing John's oldest too well. "This is _not_ your fault."

"Maybe," Dean conceded quietly. "But I knew something was off with him, and I still left him."

"You didn't want to..."

"But I _did_," Dean snapped.

"Dean, you – " Jim stopped as a weak cough interrupted him, followed by restless movement on the bed.

Dean's eyes widened as he exchanged glances with Jim, and then gently rubbed Sam's chest, being careful of the wires. "Sammy...you waking up for me, kiddo?"

Sam stilled, obviously listening, and Dean had to smile when he saw his little brother's face scrunch. A waking-up-Sammy expression didn't get more classic than that.

"C'mon, Sam," Dean encouraged. "Halfway there. Open those eyes."

Sam latched onto his brother's voice and gradually rose to consciousness, fighting his way through thick layers of hazy fog caused by the medications. His eyes slowly fluttered open and after a few moments, focused on Dean, standing next to the bed.

"Hey," he said quietly as weariness pressed him to the mattress.

Dean smiled affectionately at the sound of Sam's weak, hoarse voice, tousling his brother's hair and then resting his hand on top of the kid's head. "Hey yourself, Sammy," he replied softly.

"You're here," Sam commented, breathless.

Dean nodded. "Yep. Heard you were looking for me."

Sam smiled weakly. "'Bout time."

Dean's smile widened, heartened by his brother's response. "Go ahead. Smile and laugh it up while you can, Sammy, 'cause I'm gonna kick your ass later."

Sam laughed softly and then coughed again. "For what?"

"For scaring the shit out of me."

"Bring it," Sam whispered, dimples making a brief appearance as he smiled, for he knew that teasing was one of Dean's ways of showing affection.

Jim felt a smile tug at the corners of his own mouth, his heart warmed and his resolve strengthened by the banter of John's boys. If anyone could get Sam through this, it would be Dean. Sam drew his strength from his big brother; he always had.

"Are the two of you going to carry on like this all night?"

Dean shrugged and then winked at Sam. "Maybe."

Jim shook his head as he shifted in the chair and leaned back against the wall. "So much for my beauty rest..."

"Why don't you go home and get some rest?"

Jim shook his head immediately. "Absolutely not."

"Jim, seriously. Just for a few – "

"No, Dean. I'm staying and that's – "

"Pastor Jim," Sam said softly, his eyes closing briefly. "It's okay...just go."

"Oh," Jim said, drawing it out and nodding slowly. "I see how it is...why you wanted Dean here – so the two of you could gang up on me."

"We work better as a team," Dean said, winking again at his brother.

Jim remained silent for a moment, realizing the significance of Dean's words. "Yes, you do," he agreed, rising and crossing to Sam's bed.

"So, it's settled?" Dean asked, staring at the Pastor from the opposite side of Sam.

"What's settled?"

"You're leaving."

Jim arched an eyebrow. "Are you kicking me out?"

"Yes," both brothers answered together.

Jim smiled, loving these boys and appreciating this light moment.

"Fine," he relented after a few minutes, knowing the brothers needed this time together. "But only for a couple hours." He gently tousled Sam's hair. "You rest up and get better."

"Mm-hmm," Sam mumbled, sleep pulling at him again.

"And you behave," Jim said, turning and pointing at Dean.

"No promises," Dean admitted and then laughed at Jim's expression. "I'm gonna walk Jim to the elevators, Sam. I'll be right back, okay?"

"'Kay," Sam responded, more asleep than awake.

Dean glanced at Jim and then followed the Pastor into the hall. "I still haven't heard from dad," he reported as they walked toward the elevators. "Did you get in touch with Bobby?"

Jim nodded. "He came by a few hours ago to check on Sam and then headed out."

"Good. And if Dad's okay when Bobby finds him and I find out he was just ignoring my calls for whatever reason, I swear I'm gonna – "

"Kick his ass," Jim finished and then chuckled at Dean's disbelief in his choice of words. "Bobby and I already discussed that plan."

"It's a good one," Dean agreed. "Nice language, by-the-way."

"What can I say?" Jim shrugged. "I hang around a rough crowd."

Dean laughed in response, watching as Jim pushed the button with the downward arrow.

They stood in companionable silence as they waited for the elevator to arrive, both feeling the momentary levity fade as it was replaced with the ever-present gravity of the situation.

Dean swallowed hard against the sudden lump in his throat, the pressure in his chest. "I can't lose him."

The light above the elevator lit up as the doors slid open, spilling people into the hall.

Jim remained silent, knowing Dean didn't expect him to reply. He squeezed Dean's shoulder – _I know, hang in there, we'll figure this out_ – and stepped into the elevator.

Dean held Jim's gaze until the elevator doors closed and then sighed shakily, heading back down the hall. Moments later, he returned to his brother's room to find a young, attractive nurse – brown, curly hair...blue eyes...toned body hugged in all the right places by lavender scrubs – gently moving Sam's arms and legs.

"You're doing good, sweetie. Almost done..." she was saying as Dean entered.

"Whoa, Sammy. Didn't know you had a girl in here," Dean teased as he approached the bed. "Next time, put a towel on the door or something. Give a guy a little heads up, huh?"

Sam attempted to smile, but the pain caused by the nurse's movements of his limbs elicited a soft moan instead. His right hand crept from beneath the blankets, and he fumbled weakly for his brother.

Dean immediately stroked the length of Sam's arm and clasped his hand, unnerved by the bruises that marred his brother's flesh. "It's okay, Sam." He frowned, his attention focusing on the woman on the opposite side of the bed. "Do you have to do that?"

"Yes," she answered. "We have to keep his blood circulating. Tomorrow physical therapy will have him on their caseload, but for tonight it's just me." She paused and smiled. "I'm Karen, by-the-way."

Dean nodded but did not return the smile or his name. He couldn't care less about pleasantries and introductions right now, hot nurse or not; he could tell by the look on Sam's face that his little brother was in extreme pain and that was his sole focus.

Dean grimaced, pained himself by Sam's discomfort. "Are you almost finished?"

"Well..." Karen's voice trailed off as she lifted her eyes to check the monitors. Her gaze scanned the screens and her brow furrowed. "Actually, I think that's enough for now. I don't like some of those readings."

Dean's attention snapped to the screens, alarmed at her tone. "What's wrong with them?"

"They're still extremely low," Karen said, meeting Dean's gaze.

"Like they've been the entire time?"

"Yes, but that's not a typical response since activity of any kind usually raises most of those numbers." Karen leaned closer to her patient. "Sam? I'm going to leave you alone so you can rest now, okay sweetheart?"

Sam coughed but said nothing.

Karen directed her attention to Dean once again. "The cough is a new development and definitely something we'll need to monitor throughout the night, along with those," she said, indicating the monitors.

"Of course," Dean responded, memorizing the current numbers so he would have a baseline.

"And we'll need to monitor that as well," she added, pointing to the catheter drainage bag.

Dean nodded.

"Call me if he needs anything," Karen instructed as she quietly left the room.

Dean nodded again, not taking his eyes off his brother. Sam looked paler now – if that was even possible – and his breathing was shallow, as though he couldn't get enough air even with the extra supply of oxygen coming through the nasal cannula.

"Sammy?"

Sam's eyes cracked open in response to Dean's voice.

"You still hangin' in there?"

Sam remained silent and closed his eyes again, coughing a little louder than before.

"Sam." Dean frowned, squeezing his brother's hand. "Talk to me, kiddo."

"Dean..."

"Yeah, Sammy?"

"Don't...feel good."

_And I don't want to talk_, Dean read between the lines.

"I know," Dean soothed, placing his other hand on Sam's forehead, trying to determine if his brother's fever was up or down. Touch was such a subjective way to tell. "What can I do to make it better?"

Sam didn't verbally respond, but his grip tightened ever-so-slightly on Dean's hand, relaying the message loud and clear: _Just stay._

Dean smiled tenderly, pulling a chair closer to the bedside and sitting down as he continued to hold his little brother's hand, squeezing back. _You got it._

_**TBC**_

_**The good news: Dean's back...yay! The bad news: this will probably be my only posting this week. Blame Thanksgiving. No worries, though. We should be back on schedule next Monday.**_


	11. Chapter 11

_**So, I surprised even myself with getting this ready to post by today. It's short but sets up the next few chapters. **_

_**Happy Thanksgiving to all who celebrate it! Next post on Monday...for real, this time! **_

_**

* * *

**_

Sam woke a few hours later, shivering and plagued by multiple aches. Intense, fiery slivers of pain lanced under his ribs and dug deep into his stomach every few seconds, causing him to hold his breath as he waited for the next torturous stab.

With effort, Sam slowly turned his head to the side to look at his brother, asleep in the chair. He was opening his mouth to call Dean's name when another chill struck him, and he shivered as sweat trickled into his eyes, an absurdity considering he was freezing. Suddenly, pain flared in his stomach, and Sam gasped sharply. Dragging in an uneven breath, he squeezed his eyes shut and pressed his cheek deeper into the pillow, waiting for the pain to subside.

"Sam?"

Sam recognized Dean's voice as his brother touched his shoulder, and the contact – light as it was – sent hot pain spiraling down his arm. He moaned aloud, trying to pull away.

Dean snatched his hand away from his brother as panic seized his heart. "Sam, what's wrong?"

Sam thought about making his tongue move, but the effort of speech abandoned him. There was only sharp pain, hot and low in his stomach, coupled with the icy chill of rising fever. He coughed, tasting the bitter tang of copper in his mouth, and then wiped his lips.

_Blood, _Sam's mind screamed at the recognition of the taste and the stain on his hand.

"Holy shit."

Sam felt his heart drop at his brother's hissed curse, terrified of the fear he heard in Dean's voice.

"D'n..."

Sam gasped the word, the residual taint of blood still clinging to his tongue. Fear knifed through him as intense and crippling as the pain itself. He heard a click and then felt the mattress sink beside him and knew that Dean had lowered the bedrail and was now sitting on the bed with him, facing him.

The coughing came again, harder this time so that Sam attempted to rise on one elbow.

"Easy, Sammy," Dean murmured, lifting his brother and holding him upright as he pressed the blanket to Sam's mouth to collect the copious amounts of bright red blood.

When the spasm passed, Sam folded against his brother, slumping into Dean's chest. He couldn't stop shaking, his body spent and used from the excruciating hacking, his throat blistered and raw.

"I'm gonna get the nurse," Dean said, attempting to rise.

"No."

Sam gripped his brother's shirt. Even in the darkness of the dimly lit room he could see his hand was bloodstained, could still taste the appallingly metallic coating on his tongue. Sam knew he was breathing too fast and too shallow and tried to catch his breath.

"Don't." He swallowed painfully. "Please...don't...leave me."

"I've gotcha, Sam. It's alright; just take it easy, kiddo," Dean urged, a sense of dread growing as he recognized Sam's breathing pattern. "C'mon, Sam...you're gonna hyperventilate if you don't calm down."

Sam nodded but couldn't catch his breath. The tightness in his lungs made his chest feel like it was going to explode. Each breath came faster than the last, spurred by swiftly migrating pain and the icy clutch of fear.

Sam dug his fingers into Dean's shirt; saw his blood smeared on the fabric; felt sweat track down the side of his face. Each labored breath became critical, one painful inhalation after the next, his throat so raw he thought he would scream from the shredding pain.

Instead he hung his head and pressed harder into Dean's chest, desperate for strength – and yet, as his breath teased him with evasion, he was scared. His heart was drumming a dirge, and his mind instinctively responded with denial: _Not me. Not now._

"I...c-can't...c-can't...can't breathe," Sam gasped, vaguely aware of the increasing tempo of the surrounding monitors.

"Hey. Less freaking, more breathing, huh?" Dean cupped his brother's chin and drew his head up. "Sam, listen to me. Slow breaths...one at a time...in and out." His hand dropped to Sam's chest, trying to slow his little brother's breathing, to adjust the mercurial flow of precious oxygen by the weight of his hand. "In and out...in and out...in – "

" – and...out," Sam wheezed.

Dean smiled softly, squeezing the back of his brother's neck. _Exactly._

Several moments passed before Sam felt a lessening of pressure. Air flowed into his lungs, longer this time, expanding without as much pain. His pulse thrummed in his throat, his heart pounding. His bloodstained fingers were still hooked into Dean's shirt, bunched in a vise-like grip.

"That's it, Sammy," Dean soothed, keeping his voice calm and encouraging. "You're doing good, kiddo." He wiped his hand across his brother's forehead, mopping cold sweat. "Keep concentrating...in and out..."

Sam nodded, and slowly, his breathing returned to normal; exhausted, he leaned heavily against Dean.

Dean closed his eyes.

_Fuck._

"What happened?"

Dean jerked his attention to Karen standing in the doorway. Her cheeks were flushed and she was slightly out of breath, as though she had rushed to his brother's room.

"Hell if I know," Dean said bluntly, the last few minutes a blur. "One minute he's sleeping...and the next he's coughing up blood."

An expression of alarm crossed Karen's face as her gaze dropped from the bloodstained blanket to the pink-tinged catheter drainage bag. "And voiding it." She turned abruptly. "Page Dr. Collins," she called down the hall as she left the room in a sprint.

His heart slamming in his chest, Dean rubbed his brother's neck with gentle, firm strokes that conveyed what words couldn't. "Sammy?"

The coughing fit, combined with nearly hyperventilating had sapped Sam's limited reserves. He felt drained, too weak to open his eyes. Only half awake, he was vaguely aware of Dean's fingers massaging the back of his neck. Knots of tension melted from his shoulders as he nestled closer to his brother's warm, solid chest. Dean was here, and that was all that ever mattered to Sam.

"I'm glad...you're here," Sam whispered, as he allowed sleep to claim him.

Dean smiled tenderly, continuing to hold his little brother as tears stung his eyes. He felt his heart constrict and his jaw tighten against the emotion that suddenly surged through him.

Only Sam could do this. Only Sam could say something – something so simple – that struck to the core of his heart and brought forth emotions even he was unaware of housing.

What was it about Sam that affected him so deeply? His little brother could make him so pissed, could be such a colossal pain in the ass – and yet he could also draw up the very emotions that Dean tried so hard to keep hidden.

Dean reached out and took Sam's hand, noticing that it was still smaller than his own and feeling fiercely protective.

Karen reappeared in the doorway, followed by two orderlies clad in blue scrubs.

"Dr. Collins is on his way," she reported as they approached the bed. "We need to find the source of the bleeding; just because he's coughing up blood doesn't mean the source is confined to the respiratory tract. Blood coming from elsewhere, like his stomach, can mimic coughing up blood, so it's important for us to determine the site of the bleeding."

"Maybe it's just his throat," Dean suggested desperately. "He had bleeding after the tonsillectomy when he threw up too many times. Maybe he just coughed too much and too hard."

"That's a possibility, but not likely. We're concerned he's now bleeding into his stomach and coughing it up." Karen paused, staring down at the bag of red-hued urine. "He's also not producing enough urine, and as for the blood from the Foley..." Her voiced trailed off, clearly disturbed by the implications.

Dean fought against the rising panic and held Sam closer. "Tell me."

Karen hesitated.

"Tell. Me."

Karen sighed. "Sam's showing signs of acute renal failure as well as acute respiratory distress syndrome. Dr. Collins gave verbal orders for a chest x-ray and a CT scan, so we're going to prep him to go downstairs." She was silent for a moment before gently adding, "While we're doing that, you might want to start gathering any family or friends..."

Her voice trailed off again, and it was just as well; Dean knew the implications and didn't need to be told what he could already feel – Sam was slipping away.

_**TBC**_


	12. Chapter 12

Jim slammed the front door, his keys dropping to the floor in his rushed attempt to extract his phone from his coat pocket.

"Undisclosed number," he read aloud and then answered anyway in case it was Dean calling back from a different phone. "Dean? I've got another shirt for you. Do you need something else?"

"Jim..."

Jim blinked. "John?"

"Yeah. Where's Dean?"

Jim answered with a question, with _the_ question. "Where are you?"

"Where's Dean?" John asked again, a margin of alarm in his voice.

"Never mind, Dean!" Jim barked, feeling anger rise to an unaccustomed level. "_Where are you?_"

"At the motel in Ida Grove." John paused. "What the hell crawled up your ass, Jim? And where the hell is Dean? He's not answering his phone."

"Oh, that complaint is rich, especially coming from you," Jim responded, his tone sharp with sarcasm.

"Jim, I don't have time for this."

"No, of course you don't. You only have time for the hunt or to call if _you_ need something, but otherwise the rest of us are just – "

"Jim!" John interrupted, yelling to be heard over the Pastor's rant. "Where's Dean?"

"At the hospital!" Jim yelled back, his harsh breathing filling the silence that followed.

"He's what?"

"At the hospital," Jim repeated more evenly. "And if you would've checked your messages, you would've already known that. You would know that Dean's phone is off because he's at United in the Intensive Care Unit with Sam, which is where you should be."

"I can't check my messages because my phone is at the bottom of a damn lake, and I – " John's voice faded as if he just comprehended the second part of Jim's statement. "Wait, why is Sam in the hospital?"

_Because he's dying_, Jim silently answered feeling the anger dissipate just as quickly as it had arrived. This was the hard part.

John Winchester was competent, practical, and generous in an impersonal way that focused on the good that needed to be done. He was also tough, arrogant, and strong-willed. He was stubborn and infuriating and was not prone to having soft spots...except when it came to his boys.

Dean was his oldest, his right-hand man, his dependable soldier. Sam was and always would be the protected youngest, but he was a mystery to John – which was ironic since they were two sides of the same card, more alike than different...but neither liked what he saw.

Over the past few years, Jim knew John's relationship with Sam had become strained, constantly clashing over direct orders given and immediate obedience denied. Even so, Sam meant more to John than even John realized, and this was going to devastate him.

"Jim!" John yelled over the phone. "What's wrong with Sam?"

Jim leaned against the door and sighed. "He's bleeding internally."

"_What?_ What the hell happened?"

"He was misdiagnosed a few days ago, John. He didn't have strep and didn't need a tonsillectomy; he had – well, _has_ – mononucleosis and so when he fell on the stairs last night, he ruptured his spleen."

"Sonuvabitch," John hissed, resisting the urge to hurl the phone across the room. Why did everything always happen to Sam? He breathed deeply. "Why did he fall? Did they do surgery? Is he gonna be okay?"

"They're holding off on surgery right now, trying to keep him stable, but it's not looking good, John," Jim answered honestly. "I'm sorry..."

There was silence.

"Ah, Sam..." John sighed.

And then there was more silence.

Followed by more silence.

"John?"

John cleared his throat. "Yeah..." he answered hoarsely.

"You need to get here," Jim urged gently.

"I'm on my way," John responded immediately, the sound of swift movement muffling his voice.

"Good. I'll let Dean know, try to smooth things over."

"Yeah, thanks," John replied, acknowledging his appreciation of the Pastor's warning but knowing as well as Jim that this wasn't a situation to be smoothed over.

John knew his sons, especially his oldest, and Dean was undoubtedly pissed; by this point, Dean would be livid at what he perceived to be indifference from John over Sam's deteriorating condition.

_Fuck._

"I'll be there soon," John promised, ending the call and snatching up his and Dean's duffles as he crossed to the door.

He understood now why his oldest wasn't at the motel and hadn't checked out, why he hadn't left a note and wasn't answering his phone. It wasn't because Dean was in danger; it was because Sam was.

John shook his head. There was no telling how many voicemails he had from Dean – and from Jim, judging the Pastor's initial reaction to his call just now – trying to tell him about Sam.

"Shit," John hissed as he grabbed the weapons bag and sighed.

Maybe he couldn't help that his cell phone had been destroyed when the water sprite had unceremoniously dumped his ass in the lake – before he banished the bitch; maybe he couldn't help that he was clueless about how to check his messages from any phone but his own; but he could certainly help the order of his priorities.

"I oughta kick my own ass," John muttered as he opened the door, preparing to leave.

"Me first," came the unexpected response as the door swung wide, followed by an equally unexpected right cross punch to his face.

John staggered back, dropping the bags as he regained his balance and assumed a defensive pose before realizing the identity of his attacker.

"Bobby?" he asked, confused and pissed. "What the fu – "

Another right cross punch, followed by a left uppercut, a right jab, and then a leg sweep left John Winchester on his ass.

"Holy shit, Singer!" John panted, wiping the back of his hand across his bloody lip. "What the fuck is your problem?"

"You are, asshole."

"Bobby – "

"Shut up. Next time it'll be buckshot in your ass. Now get your shit, and let's go," Bobby ordered gruffly.

John resisted the urge to rub his ass as he stood and rubbed his jaw instead, still confused by the turn of events. "Where are we going?"

"To see the Wizard," Bobby deadpanned before rolling his eyes. "To the hospital, you damned idjit. Sam needs you."

John narrowed his eyes, feeling warmth and tightness on the left side of his face as he did so, compliments of Bobby Singer. "You know about Sam?"

Bobby nodded. "Dean and Jim couldn't get in touch with you, so – "

" – so they sent you to find me," John finished, his heart beating faster, pulsing in his bruised jaw, in his split lip, in his swelling left eye as fear clenched his gut.

He stared at his fellow hunter in silence. _It's worse than Jim said._

"It is," Bobby confirmed softly, remembering the last update he had received from Jim less than an hour ago. He turned, heading toward his truck. "So get your shit and move your ass."

And for once, John Winchester followed orders.

* * *

The steady rhythm of the monitors filled the room as Dean sat beside Sam's bed, his elbows on his knees, his hands clasped between legs. He leaned his forehead against his hands, looking down and closing his eyes at the sight of his brother's blood smeared on his shirt.

Although the bloodstained blanket had been replaced with clean linens, Dean could still see the bright red splatters on that fabric as well, could still picture the fear and panic that had shown so clearly on Sam's face. He could still hear his little brother's harsh gasps for air, the echo of his desperate, frantic plea.

_Please...don't...leave me._

Dean sighed and raised his head, shaking it slightly as if to disperse the memory. He checked the clock and then looked back at Sam.

"Jim should be here soon, Sammy," he stated conversationally, knowing that Sam was asleep, yet needing to talk, remembering the call he had made to Jim half an hour ago.

"You need to come back," he had said when the Pastor had answered the phone on the first ring. "And I need a fresh shirt."

"What? Why?" Jim's tone had been panicked. "Is he worse?"

"He's coughing up blood."

"He's what?" Jim had asked sharply.

Dean had remained silent, knowing Jim had heard him and thinking that hearing such news once was enough. "They've paged Dr. Collins, and they're taking him downstairs for a chest x-ray and a CT scan."

The sound of keys being snatched and a door being opened had preceded Jim's response. "I'm on my way."

Dean sighed. "He's on his way," he said, more to himself than to his brother, as his thoughts turned to what Jim's reaction would be to the news that Sam had never made it downstairs, had never even made it out of his room.

Dean stood up suddenly and moved to the window, staring out at the darkness as he massaged his temples and remembered; remembered how he had lowered his brother back to the bed, how he had stood and allowed Karen and the orderlies to set about their work...and how Sam had suddenly started shaking.

Tiny tremors had run through Sam's body, intensifying in strength as the monitors had increased in tempo and volume, screaming out their warnings at a deafening pitch as Sam flailed on the bed.

"He's seizing!" Karen had yelled over the din, and two more nurses had rushed into the room.

As they had entered, one of the orderlies had gently, but firmly, pushed Dean out into the hall and then had proceeded to block the doorway.

"They'll take care of him," the orderly had reassured as Dean had stared at him, speechless.

Minutes had passed – feeling like hours – before the monitors had slowed and Sam had quieted. There had been a flurry of activity around Sam for several more minutes, and then Karen had called to the orderly.

"It's okay, Mike," she had said. "He can come back in now."

Mike had nodded at Dean, and Dean had approached the bed slowly, hating how shaky and scared he felt as his eyes had scanned his brother.

Karen had turned to Dean as the other nurses and orderly had left the room. "He had a seizure."

"Well, no shit," Dean had said harshly, fear sinking its talons deeper into his heart.

"It's okay," Karen had reassured him. "Seeing something like that can be scary."

Dean snorted, thinking that was the understatement of the year. "Why did he have the seizure?"

Karen had shrugged. "Hard to say the exact reason. Of all the seizures that occur, 66% have no known cause."

Dean had stared at her. Was she serious? His little brother...his kid...his Sammy had just had a fucking seizure, and she was quoting statistics to him?

Karen had seemed to sense Dean's frustration. "Well..." she had sighed. "His urea and creatinine levels were elevated in the last blood panel we did, as well as his potassium, so an electrolyte imbalance could've caused it. Or he could have been hypoxic from nearly hyperventilating. Or he could be developing pulmonary edema from the acute renal failure, which would make it more difficult to breathe, which could lead to hypoxia. Plus, we can't forget about the thrombocytopenia, which means there aren't enough platelets in his blood, which is a direct result of his enlarged spleen and is leading to the excessive internal bleeding. His Factor V...which is a protein of the coagulation system...those levels are off as well as a few other things which would indicate that Sam's also beginning to show signs of acute liver failure, which is common and occurs in 50% of acute renal failure patients and would also lead to – "

"Shut up! Just shut the fuck up!" Dean had snapped, his voice echoing into the hall. "Jesus..."

And it was in that moment that Dean hadn't known which was worse – not knowing...or knowing.

Karen had blinked at him, biting her lip and shifting uncomfortably. "I'm..." She had cleared her throat. "I'm sorry."

Dean had ignored the apology, knowing he should have offered his own – and knowing if Sam had been awake, his little brother would've bitchfaced him into submission; but Dean had been well beyond minding his manners.

"Won't the CT scan tell the cause?" he had asked, irritated and pissed...at her, at himself, at the entire situation.

"Possibly..." Karen had answered, regaining her composure. "But the orders weren't for a head CT. Anyway, it doesn't matter now; we're not moving him. We've replaced the nasal cannula with an oxygen mask to help increase his O2 sats. He'll probably end up on a vent later, but right now we're just trying to keep him stable and wait for Dr. Collins to arrive to see how he wants to proceed."

There had been a pause before Dean had blurted a question that had surprised even him.

"Is he dying?"

Karen had shaken her head frantically. "Don't think like that."

Dean had stepped closer to her. "I need to know. Because if he is..."

His voice had faded, unable to fathom a world without Sam.

Karen had stared at him for a moment – clearly at a loss for what to say – before shrugging in resignation. "I don't know," she had said softly as she had quickly left the room.

_I don't know._

Dean sighed as he moved back toward the bed, his gaze flickering to the monitors before coming to rest on his sleeping brother.

For most people in most situations, knowing was easy; saying it aloud was the hard part. And whether Karen or Dr. Collins or Jim or even himself wanted to say it, they all still knew the truth: Sam was dying.

Dean sank back into the chair.

Over the years, he had learned one of the most important lessons when it came to Sam – wait and see. If Sam was in one of his moods, just wait and see when he'd snap out of it. If he was arguing with John, just wait and see how long it took him to get over it. It was true with just about anything. The old adage was right – time often had a way of working things out, of making things better.

And yet now, time, rather than diminishing the hurt, only seemed to sharpen the pain. There was no time to wait and see. His brother was slipping away, and the emotions Dean felt were so strong it were as though his soul actually spasmed with unbearable sadness. How much did heartache weigh? How heavy was the burden when the person you loved most was slipping away before your eyes?

Suddenly overwhelmed by emotion, Dean leaned forward, putting his head down on Sam's bed.

"I can't lose you, Sam. I just _can't..._" he whispered as the soft sound of his weeping penetrated the silence, a slow-growing release of anguish that knew no boundaries, no comfort.

Dean wasn't being overdramatic when he said he couldn't live without Sam – he literally _couldn't_ – and his own desperation and fragility in that moment unnerved him. He allowed tears to slip through his lashes and felt them glide down his cheeks as he silently cried, releasing a flood of emotion that rarely surfaced.

Several minutes passed before Dean drew a quiet, shuddering breath and then became aware of a feather-light touch on his head.

Looking up, he saw Sam had opened his eyes just a slit and was watching him. With great effort, Sam slowly lifted his hand and slid the oxygen mask from his face, pushing it down so it hung awkwardly around his neck.

"Love you...too," Sam said faintly, his voice hoarser than normal.

Dean laughed wetly and smiled. His little brother could always see right through him. He nodded in response, unable to trust his voice, and placed his hand on Sam's head, fingers splayed beneath damp bangs, his thumb gently rubbing his brother's warm forehead as silence settled between them.

Sam moved restlessly as he wheezed and then coughed.

Dean frowned, reaching for the mask around his brother's neck. "You need to keep this on, Sam," he gently chastised, moving it up to the kid's face but pausing when Sam turned away. "Sammy..."

"I'm s-sorry."

Dean shook his head slightly. "For what, kiddo?"

"Scaring you." Sam's eyes closed briefly. "Know you...hate that."

"Shhh...it's alright, Sammy," Dean soothed, his voice quiet. "I'm alright."

Sam's eyes cracked open again as he smiled weakly. "Liar."

Dean returned the smile and chuckled, his heart constricting as he stared into the tired eyes of his little brother and carded his fingers through the kid's floppy hair. Sam was being so brave it hurt.

Dean scowled in mock irritation even as one corner of his mouth turned up. "Who you callin' a liar, bitch?"

"You...jerk." Sam closed his eyes. "Where's Dad?"

Dean blinked, startled by the question. It was the first time Sam had mentioned John, and Dean wasn't sure if him asking now was a sign of concern, curiosity, or finality.

Sam opened his eyes again, waiting.

"I don't know," Dean admitted.

Sam didn't look surprised. It was the answer he had been given most of his life whenever he asked about the whereabouts of their father.

"Is...he coming?"

Dean sighed, hating this. "I've left messages, but..." He shrugged, not knowing what to say and feeling simultaneously helpless and pissed. "I don't know."

Sam seemed to consider the information. "Is he...mad...at me?"

Dean stared at his brother, feeling the warmth of anger blossom in his chest and slowly spread through him, only to be chased by the chill of sadness.

John wasn't there, might not even be on his way, and Sam immediately assumed it was because their dad was mad at him. Mad at him for not sucking up a sore throat; for disrupting a hunt in favor of "routine surgery"; for not recovering fast enough; for getting injured and then having the nerve to get even sicker; for not being strong enough and tough enough and everything else John Winchester expected of his sons.

Dean shook his head. "No," he responded, louder than he intended. "He's not mad at you, Sammy, you hear me?"

_But I am fucking pissed at him,_ Dean silently seethed.

Sam nodded, but his eyes misted and his voice hitched as he spoke. "I kinda...wanna...s-see him."

"I know," Dean soothed, blinking against the sting of tears in his own eyes as he lightly squeezed his brother's arm.

Sam wheezed a sigh, his eyes dipping closed. "I'm tired."

"I bet you are," Dean agreed, wondering if Sam remembered what had happened, if he remembered the coughing...the blood...the seizure. "Go back to sleep."

Sam gave a slight nod, and Dean positioned the oxygen mask over his brother's face before he leaned back in the chair, stretching his legs in front of him, trying to relieve the stiffness that had settled in his muscles from sitting too long.

After a few moments, Sam sighed again, but Dean knew he wasn't sleeping; he was thinking.

"Dean?" Sam asked, his voice muffled by the mask.

"Yeah, Sammy?"

Sam's hand fluttered, motioning toward his face, and Dean lowered the mask.

"Sam, you can't keep talking. You need to leave this on and rest."

Sam opened his eyes and shook his head weakly. "I have...to say...something." He swallowed. "Need you...to...do something...for me."

Dean leaned closer to his brother, his face compassionate and attentive, as it always was when Sam used that tone. "Of course, Sam. You name it."

Sam moved restlessly on the bed, his breaths beginning to come in short bursts, his sides and chest pulling painfully in warning. "I need you...to promise..." he swallowed again, "...to promise...me something."

Dean nodded slowly, a feeling of dread rising in his stomach. "What, Sam?"

Sam stared at his brother, tears welling in his eyes and then spilling over, gliding down his cheeks.

"Hey..." Dean soothed, rubbing his brother's arm as his thumb swept the moisture from the kid's flushed cheeks. He could take anyone's tears but Sam's. "C'mon, kiddo. It's okay..."

"I'm sorry," Sam apologized as tears continued to rim his eyes.

"You don't have to keep apologizing, Sam."

"I know. It's just..."

Sam hesitated.

Dean smiled encouragingly, his thumb slowly rubbing the crook of his brother's elbow. "It's just what, Sammy?"

"I'm...I'm s-scared, Dean."

Dean clenched his jaw. _So am I._

"That's normal, Sam," Dean said as much to himself as to his brother.

"No," Sam responded, shaking his head slightly. "Not...for me...not really."

_Who's the liar now_, Dean thought affectionately.

Sam wheezed, breathless. "I'm...more afraid...for you."

Dean narrowed his eyes and cocked his head, confused. "Me?"

Sam nodded.

"Don't worry about me, Sam," Dean reassured. "You need to worry about you. You need to get better, huh?"

Sam shook his head weakly. "I'm not...getting...better."

"You will," Dean replied instantly, his tone harsh from fear and anxiety. "You _will_."

"I won't," Sam stated simply as fatigue pulled at him, as his breath teased him. "And...I'm afraid...that..." He breathed noisily. "...when...the time...comes...you won't...let me go."

Dean stared at his little brother, speechless. His eyes glistened with emotion, and his heart slammed in his chest. He didn't want to have this conversation. Sam knew him too well.

"P-promise me..." Sam said, his hand seeking his brother's.

Dean's fingers laced with Sam's as he grasped the kid's hand, palm against palm. "Promise what, Sam?"

Tears welled again in Sam's huge eyes. "Promise me...you...will let...me go."

Dean bowed his head and pressed their clasped hands to his forehead. "Sammy – "

"Dean...please..._please..._promise."

Dean said nothing, his harsh breaths mixing with the wheezes of his brother and the constant hum of the medical equipment. Anyone that knew him knew how much he loved his little brother and how he would do anything for Sam – but not this. He couldn't promise this. There was no way in hell he was letting Sam go – certainly not now...and maybe not ever.

Dean lifted his head, stubborn determination flooding his heart. "No."

"Dean – "

"No," Dean repeated, shaking his head for emphasis. "It's you and me against the world, remember? And I'm not letting you leave me here alone."

Sam shifted on the bed, coughing as he became more agitated, and then flexed his head back, pushing into the pillow as he tried to draw a deep breath. "But...Dean...I – "

"Hey. Easy..." Dean stood, releasing Sam's hand as he slipped the oxygen mask up over his brother's chin, carefully adjusting it over the kid's nose and mouth. "Deep breaths, huh? Calm down, you're okay."

"No." Sam shook his head, legs moving restlessly beneath the sheets, hands bunching the blanket as fresh tears appeared. "Not...okay," he sobbed, the mask fogging. "I'm...not...o-okay." Sam's brave front completely crumbled. "Dean..."

"Ah, Sammy..." Dean sighed, feeling his heart constrict at Sam's expression and tone as he lowered the bedrail and gently pushed against his brother. "Make room," he said as he settled beside Sam, mindful of the wires and IV lines.

Dr. Collins or Karen or whoever could bitch all they wanted about hospital rules forbidding visitors to be on patients' beds. But Dean knew his little brother, and this was what Sam needed.

"C'mere, kiddo..." Dean whispered as he lifted his arm and felt Sam immediately latch on to him, curling against his side, head resting on his chest, hand grasping the amulet.

Dean pulled the blanket closer around his brother as Sam sighed shakily in a mixture of tears and exhaustion and nestled even closer. Dean smiled affectionately and was reminded of that night at Jim's house when all they had to worry about was Sam recovering from a routine tonsillectomy. It was hard to believe that was only four days ago; that only four days ago, Sam was relatively okay.

Dean sat there several minutes, lightly resting his chin on Sam's head as he softly hummed – over and over – the opening chords of "Smoke On the Water," while he rubbed his little brother's back and listened as the kid's breaths slowly evened out.

"Better?"

Sam's head moved along Dean's collarbone, his hair tickling Dean's neck and chin as he nodded and then relaxed more heavily against his big brother.

"Good." Dean paused. "Now you listen to me. I know you're sick and you feel like shit and you're so tired you just want to stop fighting, but you can't. I _cannot_ lose you, Sammy." Dean glanced down, seeing Sam's eyes were closed but knowing the kid was still listening. "You wanna know why I can't lose you?"

Dean didn't wait for a response.

"I can't lose you because I haven't taught you how to drive yet...or how to hustle pool...or how to kick ass, then haul ass after you've hustled pool." Dean chuckled. "I haven't given you tips on how to make it to third base on the first date...or in your case, how to even get a first date." He carded his fingers through Sam's hair. "I haven't had the chance to get you drunk yet – even though I'm pretty sure you're gonna be a lightweight and incredibly sappy when you're wasted – but that'll just make it easier to talk you into karaoke before taking you home, cleaning you up, putting you to bed...and then making you feel even worse the next morning."

Dean grinned at the future fun he would have at his brother's expense and then sighed, feeling tears prick his eyes at the all-too-real possibility that, given Sam's current condition, it would never happen.

And that wasn't going to happen. Not on his watch.

"But the main reason I can't lose you, Sammy, is because you're the reason I get up every morning. It's all you, little bro. Without you, there's no me." Dean's hand covered his brother's as it rested on his chest. "So, here's the deal, kiddo: I'm not giving up, so you're not giving up. I'm gonna figure this out...I'm gonna figure out the best thing for us to do to beat this...but I need you to fight just a little while longer, okay?"

Several moments passed before Sam swallowed noisily and drew a labored breath, fingers twitching as he weakly squeezed Dean's hand in response. _For you...okay._

_**TBC**_


	13. Chapter 13

Jim had a sense of déjà vu as he entered the Intensive Care Unit, shoes softly squeaking on the waxed floor, plastic bag crinkling in his grip. The corridor was quiet and dimly lit, much like his upstairs hall had been Tuesday evening when he had checked on the boys before he had gone to bed.

Had it really only been four days since he had laughed at Dean's outrage over some _Wheel of Fortune_ contestant not knowing the name of his favorite Zeppelin song? More amazing than that, had it really only been six hours since Sam had been admitted?

It felt like a lifetime.

In the buzz of medical terminology and the hum of monitoring equipment, in the midst of hard questions and even harder answers, their world had been reduced to one small room and one scrawny kid; time hadn't mattered as it passed by. And now, in another ten minutes, it would be a new day, and Jim was afraid of what it would bring.

Jim sighed as he stopped at the edge of Sam's door and peered through the thin window, feeling tears prick his eyes at the sight of Dean lying on the bed next to Sam, eyes closed and doing what he did best: taking care of his little brother.

"They've been that way for the past half hour," Karen reported, startling Jim as she joined him at the door's window. "I've passed by here at least a dozen times with the intention of telling Dean he's not allowed to sit on Sam's bed, but I – "

"Considered the benefits of self-preservation and changed your mind?"

Karen laughed lightly. "Something like that," she replied, knowing the Pastor wasn't joking; Dean was formidable when it came to his brother. "I just couldn't bring myself to do it. Sam seems soothed and peaceful, and Dean just seems – I don't know..."

"Content," Jim supplied, still looking through the window.

Karen nodded. "Yeah. I guess that's a good description, but it seems a little strange given the situation."

"I suppose," Jim agreed. "But if Sam's fine, Dean's fine. That's how it's always worked."

"But Sam's not fine," Karen gently reminded. "Not at all."

"The boys have learned to live in the moment." Jim smiled sadly, staring through the window. "So right now – in this minute – they're together, and they're fine, and that's enough to make it to the next minute and the next and the next..."

Karen's eyes glistened with moisture. She had never heard something so beautifully sweet. "Sorry," she said, waving her hand to ward off further tears as Jim glanced at her. "Patients don't usually affect me like this."

Jim nodded knowingly. The Sam-and-Dean combo had been wreaking havoc on his emotions for years.

Karen sniffled and glanced at the Pastor. "Did Dean tell you?"

Jim returned the glance. "About Sam coughing up blood? Yeah..."

"And the seizure?"

Jim blinked. "What?"

Karen nodded. "He had a grand mal almost immediately following the hemoptysis. Well..." She reconsidered her word choice. "I guess I can't call it that, since we're not sure that the blood was coming from his respiratory tract. We were going to do a chest x-ray, but the seizure changed our plans. So instead, we adjusted his meds and put him on an oxygen mask to hopefully increase his O2 sats. Our main concern has been trying to keep him stable until Dr. Collins arrived."

"Where is he?" Jim demanded, patience having thinned at "seizure" and completely vanished at "grand mal".

"He's here," Karen assured. "He just arrived. In fact, I was coming to tell Dean that Dr. Collins is on his way up."

"I'll tell him," Jim replied, his tone signaling the end of their conversation as he pushed through the door, immediately attracting Dean's attention.

Dean's eyes were instantly open and glaring, his expression a nonverbal warning to fuck off, while his arms tightened around his little brother.

"It's just me," Jim soothed, approaching Sam's bed and pulling Dean's shirt from the plastic bag he held as if it was a peace offering.

Dean nodded, glancing down at Sam before carefully extracting the amulet from the kid's grasp – large fingers gently sliding under smaller fingers, loosening one-by-one – and then easing out from under his little brother's weight. He paused, watching Sam as he shifted, and when his brother settled, Dean stood to his full height, lacing his hands together, stretching his arms over his head.

As the fabric of Dean's shirt shifted across his chest, Jim's eyes were drawn to the rust-colored stains streaked and then clustered as though someone had reached and then clung.

Jim swallowed against his dry throat, knowing it wasn't just someone's blood; it was Sam's.

And there was a lot of it.

Dean lowered his arms, closing his eyes as he leaned his neck to the left and then to the right. "He's okay right now," he assured as he stretched stiff muscles, feeling them burn as tension briefly released its grip but also feeling Jim's gaze, knowing the Pastor's thoughts.

There was silence.

Dean opened his eyes. "Jim?"

Belatedly, Jim nodded, cleared his throat, but said nothing. He had spent the majority of his life offering words of hope and comfort and yet now...he was speechless.

After a few moments, Dean returned the nod, seeming to understand. He sighed.

"Everything okay in the hall?" he asked as he accepted his clean shirt from Jim.

Jim was startled by the question and then smiled at himself. He should have known that just because Dean had appeared to be asleep moments before, just because the lights were dim and the door had been closed, was no reason why this hunter – or perhaps more importantly in this situation, this big brother – didn't know exactly what was going on around him.

Dean looked expectantly at Jim before pulling the bloodstained shirt over his head and replacing it with the one the Pastor had brought; the one he had left behind in the laundry on Wednesday when he left to join John; the one he had been wearing the day Sam had his tonsils removed.

"Hard to believe that was just four days ago," Dean commented and saw Jim nod as though the Pastor followed his train of thought. He shook his head. "So, what did Karen say?"

Jim took the soiled shirt from Dean, folding it inside out before stuffing it inside the bag and dropping it in the chair by the door. "She said Dr. Collins is on his way up."

Dean nodded, standing by the bed, staring at Sam. "Good."

Jim returned the nod as he approached the bed and stood opposite Dean, then paused.

Dean glanced at him. "What?"

Jim cleared his throat. "I have more good news."

Dean narrowed his eyes, suspicious but listening.

"Your dad called."

Dean arched an eyebrow. _And?_

"He's on his way."

Dean snorted. _'Bout fuckin' time..._

"Dean..."

Dean pierced the Pastor with a glare. "Don't."

Jim was startled by the intensity of Dean's expression. "Don't what?"

"Defend him."

"I wasn't – "

"You were," Dean snapped and then nodded, affirming what they both knew was true. "He called and gave some lame excuse or sob story and now you feel sorry for him and were going to defend him and try to smooth things over with me before he gets here, but you know what? I don't care."

Jim sighed. Sometimes he hated always having to play the role of peacemaker. "Dean, his phone was – "

"Was what?" Dean interrupted. "Destroyed? Stolen? Lost?"

"It's at the bottom of a lake...or something." Jim shrugged, indicating he didn't know the entire story, but his tone implied he believed it.

Dean snorted. "It doesn't matter, Jim." He shook his head, hands gripping the bedrail, knuckles white as he battled to keep his anger in check, to keep his voice quiet. "This whole situation is so far beyond a stupid phone."

"Meaning?" Jim asked hesitantly, though he already knew.

"Meaning Dad's an ass!" Dean yelled. "A selfish ass who is so obsessed with revenge that he only thinks about the hunt and doesn't give a flying shit about the rest of us! And you know what? We let him! He gives excuses, and we buy into them – hell, sometimes even supply them ourselves – and I'm fuckin' sick of it!"

There was silence, filled with Dean's harsh breathing and the steady cadence of the monitors.

Jim sighed. "Dean, I know you're angry – and you have every right to be in this situation – but John's only doing what he thinks is right, what he thinks is best to keep you and Sam safe. He's doing the best he can."

"I used to believe that," Dean stated with the quiet intensity of one who had lost faith. "But not anymore."

"Dean..."

Dean averted his gaze, effectively withdrawing from the conversation, glancing at the monitors before focusing back on Sam.

Jim narrowed his eyes, uncomfortable with the sudden change in John's oldest.

Dean was eerily silent, his jaw clenched, his expression unreadable.

If Dean had been a parishioner, Jim would have expounded on the virtues of forgiveness, would have warned about the downfalls of a grudge-bearing heart.

But Dean wasn't a parishioner.

At this moment, in this situation, Dean wasn't even a fellow hunter or a friend's son; he was a big brother grappling with the fact that his father had committed the ultimate unforgivable sin – jeopardizing his little brother, his Sammy.

John had put the hunt above Sam three separate times – by not accompanying the boys to the clinic...by not returning for Sam's tonsillectomy...and perhaps the worst, by calling Dean away during Sam's recovery.

The combination of those transgressions, along with John's perceived indifference concerning Sam's rapidly deteriorating health over the past several hours, had culminated in this – an impasse.

Jim sighed and opened his mouth to speak but stopped when a brief knock on the door heralded the arrival of the doctor, followed by Karen.

"Okay," Dr. Collins began, wasting no time on pleasantries. "The OR's on standby. We're prepping Sam for surgery."

Dean exchanged glances with Jim, their conversation momentarily forgotten, the anger instantly disappearing as he felt a rise of hope – at least they were finally _doing_ something – then a spike of panic. "Is he stable enough for surgery?"

"At this point, it doesn't matter," Dr. Collins replied bluntly. "It's likely Sam will never be stable enough for surgery, and we can't keep waiting. His spleen is showing no signs of clotting itself, and Sam's organs are beginning to shut down." He paused. "I'm sorry..."

Dean felt his heart slam in his chest, not knowing much about the procedure Sam was about to endure but knowing a doctor's apology before surgery wasn't a good sign.

Dean glanced again at Jim and then sighed loudly, turning back to Sam just as the monitors started to blare their warning, just as his little brother made a strangled sound and then went rigid.

Dean felt the color drain from his face in realization, instinctively grabbing his brother's flailing arms. "Oh God...not again. Not again, Sam! No!"

"What's happening?" Jim asked anxiously.

"He's seizing!" Dr. Collins yelled, rushing to his patient, as the room immediately erupted in frantic chaos.

Dean and Jim were unceremoniously pushed back from the bed as two more nurses rushed into the room.

"Sats are 80 and dropping," Karen reported, eyes scanning the monitors for other information.

"He's hypoxic..." Dr. Collins said to himself.

"ARDS?" Karen asked.

"Most likely," Dr. Collins agreed and then directed his attention to the other two nurses. "Nicole, get me an intubation tray _now_, and Claudette, push 4mg of Ativan into this kid. We've got to get this seizure under control." He glanced across the bed. "Karen, page respiratory and tell them to meet us downstairs, then call the OR and tell them we're coming as soon as this tube is placed."

Karen nodded, her eyes locking with Dean's – _I'm sorry_ – as she left the room.

Dean watched in horror as the scene played out in front of him, so focused on his brother that he didn't feel Jim standing beside him, didn't feel the Pastor's hand on his shoulder.

"Sammy, I'm here," Dean called, feeling helpless and useless and so fucking scared.

With the help of the medication administered through his IV line, Sam's seizure slowly began to abate, and Dean shared a sigh with Jim and exchanged glances.

"Where the hell is that intubation tray?" Dr. Collins barked.

"Right here," Nicole responded, tearing open the tray and passing the materials to the doctor.

Dr. Collins arched Sam's head back as he slid the metal tongue blade of the laryngoscope into his patient's mouth, preparing to intubate. The laryngoscope descended Sam's throat, then the tip of the endotracheal tube advanced down into his trachea.

"I'm in," Dr. Collins reported as Nicole taped the tube to the corner of Sam's mouth and Claudette attached the ventilator. He pressed his stethoscope to Sam's chest, listening intently. "Good breath sounds bilaterally. What are his sats?"

"Ninety and climbing," Nicole instantly responded.

"Good." Dr. Collins wrapped the stethoscope around his neck as the nurses unplugged the monitors, preparing for transport. "Let's move."

Dean and Jim separated, standing on either side of the door as Sam's bed was pushed over the threshold, then fell in line beside him as he was wheeled down the hall toward the elevators.

Dean grabbed Sam's hand as he kept pace and glanced at Karen as she joined them.

"OR's ready," she reported, breathless in her rush.

Dr. Collins nodded tightly and pushed the down arrow button.

Dean felt his heart climb into this throat. He knew he wouldn't be allowed to board the elevator, wouldn't be allowed in the OR.

This was it.

Dean leaned down, pressing his forehead to Sam's temple. "Remember what we talked about, Sammy," he whispered over the whoosh of the ventilator, hoping his brother could hear him. "You keep fighting..."

The elevator arrived in a series of dings and sliding doors.

Dean squeezed Sam's hand for good measure and felt his brother's fingers twitch against his palm before he was wheeled away.

Despite the seriousness of the situation, Dean smiled, taking that slight movement for the answer he knew it was – Sam had heard him; he remembered; and he would fight because his big brother had asked.

"That's my boy," Dean murmured as the elevator doors slid shut.

_**TBC...probably on Monday**_

_**ARDS = Acute Respiratory Distress Syndrome**_


	14. Chapter 14

Bobby answered his phone halfway through the first ring. "Jim?"

"Yeah. Is John still with you?"

Bobby's gaze flickered to his rearview mirror. "Yep, following behind me. How's Sam?"

Silence met his question.

Bobby frowned, his grip tightening on his phone. "Jim..."

"He just got out of surgery."

"Surgery?" Bobby repeated. "What for?"

"They had to remove his spleen."

"Jesus. That as serious as it sounds?"

"I don't know," Jim answered honestly, his tone relaying his worry and fear as he walked down the hall toward the elevators. "It was an emergency situation, so there wasn't time to explain, and then Sam seized again and they had to put him on the ventilator and – "

"Hold on a minute, Jim. I'm gonna get John," Bobby said as he flashed his truck's signal and then pulled over, tires crunching the gravel beside the road. "He needs to hear all of this."

"I agree, that's why I'm calling."

Bobby narrowed his eyes. "Why isn't Dean calling?"

Jim sighed, the volume and the force indicating his level of frustration.

Bobby nodded, having his answer. He had dealt with a pissed off Dean himself; he knew what the Pastor was up against. "Sounds about right."

Jim chuckled, sounding tired.

"I wouldn't worry about it, Jim. Dean's been pissed at his daddy before."

"Not like this," Jim corrected, as he approached the elevators and pushed the downward arrow button.

Bobby shrugged. "Maybe not, but he'll get over it. He always does when it's John."

"Yeah..." Jim sighed again, quieter. "But I don't know, Bobby. You haven't seen him. I don't think it's going to be that easy this time. It's different..."

"Well..." Bobby's voice faded.

There was nothing to say to that. It was hard to argue with the truth, and he didn't blame the kid, was actually proud of Dean for standing his ground on this one. They had all enabled John Winchester for entirely too long.

There was silence as Bobby watched John pull over behind his truck.

"Alright, hang on..." Bobby's voice was drowned out by an 18-wheeler that passed as he climbed down from his truck. He couldn't help the small smile that twitched on his lips at the sight of John's battered face – _serves you right, asshole –_ as the oldest Winchester closed his own truck door and approached.

"Is that Dean?" John asked urgently, reaching for the phone.

Bobby didn't respond but instead pushed a button before setting the phone on the warm hood of John's truck. "Alright, you're on speaker..."

"Dean, how's Sam?" John asked immediately, staring at the phone and then searching Bobby's face for clues as to whether his fellow hunter already knew the answer to that question.

There was silence.

John felt the rise of panic. "Dean?"

More silence.

"Dean!"

"John, it's me."

"Jim?" John glanced at Bobby. "Where's Dean? What's going on?"

"Sam's out of surgery, and – "

"Surgery?" John yelled. "What the hell? Why are you just calling me now? And where the hell is Dean?"

Jim closed his eyes briefly as he waited for the elevator, drawing on patience that he kept stored just for dealing with John Winchester, especially when he himself was exhausted. "There wasn't time to call before surgery, John."

"Fine," John snapped. "But where's Dean? Why isn't he calling?"

_Because he's sick of your shit_, Jim silently answered and then smiled, amused at the things that crossed his mind when he was this tired and imagined people's shock if they could hear the thoughts of Pastors.

"Jim!"

Jim's eyes snapped open at the volume of John's voice and the sound of the elevator finally arriving. "Dean was just paged down to recovery. I'm on my way as well."

"What? Why? What happened?"

"Calm down, John," Jim soothed as he stepped on the elevator. "Sam woke up from the anesthesia earlier than they expected and became agitated, especially since he's still on the ventilator, so they called Dean. They've increased his sedation but – "

"Wait a minute...Sam's on a ventilator?"

Jim paused. "Yes."

John looked a Bobby, alarmed. "Why?"

Jim sighed, exiting the elevator and scanning the hall, looking for Karen. "Because he had a seizure – two, in fact – and wasn't getting enough oxygen, so they intubated him before taking him down for surgery."

"Sonuvabitch," John hissed, rubbing his hand down his face. This did not sound good. "Why did they page Dean to recovery? Is there a problem?"

"I don't think so." Jim focused on the room at the end of the hall, seeing Karen exit, and then walked in that direction. "Sam's nurse just said she thought it would be best if Dean came down to be with Sam." He nodded as he passed Karen and paused in the doorway of Sam's room, smilng softly. "And I think she was right," he commented at the sight of Dean sitting on the edge of Sam's bed, one hand holding his little brother's and the other gently carding through the kid's dark hair.

Sam stared drowsily at his brother, eyes staying closed longer between each blink.

"Stop fighting it, Sammy." Dean's voice was quiet as he smiled softly, thankful it was sleep his little brother was now fighting and no longer the ventilator. "I'm here. You're okay. Go to sleep."

Sam continued to stare at Dean for a few more seconds before closing his eyes, instantly swept under by the potent combination of exhaustion and sedation.

Dean lightly chuckled, affection shining in his eyes as he gave a final stroke to Sam's hair. "You're a stubborn little shit, you know that, Sammy?"

Jim chuckled as well, and Dean glanced over his shoulder at the Pastor standing in the doorway.

"Wonder where he gets that from?" Jim commented as he approached the bed.

Dean smiled, shrugging and then looking pointedly at the phone Jim held.

Jim swallowed, covering the phone with his palm, hoping to muffle whatever Dean's reaction would be. "It's your dad," he informed and held his breath, expecting the worst, hoping for the best.

He got neither.

Although Dean said nothing, his eyes narrowed, and Jim heard the message loud and clear: _Traitor._

Dean held the Pastor's gaze, making his point, and then returned his attention back to Sam, one hand still holding his brother's while the other rested lightly on Sam's chest, his own form of monitoring the kid's vitals. Dean could feel Sam's heartbeat, could measure his breaths; he would know before the monitors did if there was a problem with his little brother.

Jim sighed, a bit unnerved by the lack of verbal reaction – a silent Dean was more worrisome, more alarming than a ranting Dean – and pressed the phone's speaker button.

"John, Bobby...you're on speaker," he reported, holding the phone between himself and Dean.

"Dean?"

Dean remained silent, purposefully making his dad wait; a nonverbal reminder of who had control in this situation.

"Yeah..." he finaly responded.

John sighed harshly. He knew what Dean was doing. "How's Sam?"

"I'm with him," Dean replied, as though that was answer enough, as though it was a given fact that if he was with Sam, then Sam was okay. "Where are you?"

John shook his head, glancing over at the line of trees that bordered the highway as he tried to hold his temper in check. He knew this angle, too. Dean wasn't really interested in his location; the question was a barb, an attempt to not only emotionally wound John with guilt – _I'm here...where are you?_ – but to also lure him into a verbal sparring match, and John wasn't taking the bait.

There would be time for that later.

John directed his attention back to the phone. "We're still about two hours away."

Silence met the response, and Bobby rolled his eyes, irritated by yet another Winchester pissing match. He was getting too old for this shit.

"Dean, it's me."

Dean's tone changed at the sound of Bobby's voice. "Hey, Bobby."

Bobby glanced at John. He felt like a mediating talk show host. "Jim said Sam just got out of surgery."

"Yeah, they had to remove his spleen."

"And what does that mean for Sam?" John asked sharply, looking at Bobby.

Bobby shrugged as Dean answered likewise.

"You don't know?" John repeated, anxiety making his tone harsh and causing his verbal filter to malfunction. "Damnit, Dean! Hasn't Sam suffered enough? Haven't you already learned your lesson about letting your brother have surgery when you don't know?"

The words had no sooner left John's mouth than he wished he could have called them back. That's not what he had meant to say, what he had wanted to say. Not at all.

John shook his head. "Shit..." he hissed, audible only to himself and Bobby.

He felt the intensity of Bobby's stare and took a step back, recognizing his fellow hunter's expression and not wanting to be punched again. He could only imagine Jim's expression. And as for Dean...

John sighed, grateful – not for the first time – that Mary couldn't see what a monumental failure he was as a father. "Dean, I'm sorry. That's not what I – "

"You know what, Dad?" Dean asked, his voice steady and eerily calm. "Fuck you."

Dean glanced up at Jim's sharp intake of breath, but he wouldn't apologize. He had never meant those two words more than he did in that moment, had never been so pissed, had never wanted to punch his own father as much as he did right then.

John had been gone for days, had been indifferent to Sam's initial illness, had offered no input and had left major decisions up to Dean about his little brother's health, and now he wanted to sit in judgment of the results of those decisions?

No.

_Hell_ no.

Fuck that. And fuck him.

Dean snorted his disbelief and disgust and turned away from the phone Jim still held, focusing on his brother, thankful Sam wasn't awake for this conversation...even if – as far as Dean was concerned – this conversation was over.

For once, John was speechless, and Bobby's expression of fond approval at Dean's words as he stared at the phone didn't help.

John inhaled deeply and slowly let it out. He had it coming – he knew it, they all knew it. But to actually hear Dean say it was simultaneously enraging – _how dare his son talk to him like that _– and heartbreaking. John would do anything for his sons, and yet as good as his intentions were, he always seemed to do the wrong thing, or worse...nothing at all when they needed it the most.

John glanced at Bobby. _How am I ever going to make this right?_

Bobby shook his head, his expression having changed to slightly sympathetic. He didn't know the answer to John's unspoken question, and he certainly didn't envy the task of figuring it out and carrying it through. Because Jim had been right; this time, it was different.

Jim felt numb, the phone heavy in his hand as he stared at Dean, saddened by the turn of events. They should be coming together, not falling apart.

Dean didn't acknowledge his gaze, and the Pastor knew that John's oldest was done; he had said what he meant, had meant what he said, and that was it. There would be no apology – at least not now – because Dean didn't feel sorry; he felt hurt, and that was always portrayed as anger with John's oldest.

Jim slowly shook his head – at a complete loss for words – and was startled by the sound of Karen's voice.

"Everything okay in here?" she asked from the doorway as she tucked a curl behind her ear.

Jim glanced at Dean, uncertain of how to respond. Had she heard?

Karen smiled, amused at the Pastor's confusion. "Is Sam okay? Does he need anything?" she amended coming into the room to see for herself.

"Oh..." Jim replied, feeling embarrassingly dense. Even now that he knew what she was asking, he wasn't sure how to answer her question. He was ashamed to admit to himself that in the midst of John and Dean's exchange, he had momentarily forgotten about Sam.

But Dean hadn't. Big brother first; everything else second.

"No, he's fine," Dean responded, smoothing the blanket over Sam's chest.

"Is that Sam's doctor?"

Dean glared at the phone as his father's voice drifted into the room.

There was silence, and when no one answered, Karen stepped closer to Jim, raising her voice, as people tended to do when they spoke on speaker phones.

"I'm Karen, Sam's nurse. And you are?"

"Sam's dad."

"Oh."

Karen flushed at the blatant surprise in her tone. Of course Sam had a dad. Why did she feel speechless at that revelation? She had read Sam's chart. His mother was deceased, not his dad. His dad was just...not there.

Karen cleared her throat. "Nice to meet you," she offered, feeling awkward.

Dean snorted, and Jim cut his eyes in nonverbal reprimand at John's oldest.

Karen glanced from the Pastor to Dean to the phone, wary of the tension that permeated the silence, and was thankful when John's voice floated to her again.

"Where's the doctor?"

Karen checked her watch. "He's – "

"Here," Jim reported, nodding toward the door, his words attracting Dean's attention.

Karen turned in time to see Dr. Collins enter the room, coming to stand beside her and Jim and arching an eyebrow at the phone held between them.

"Sam's dad," Karen commented as way of explaining why there was a cell phone in an area where the devices were usually not permitted.

"And his uncle."

Karen cocked her head, startled by another voice coming from the phone and slightly irritated that she hadn't been told someone else was present on the opposite end of the line. Was it just her, or was it rude to be a silent listener without the other person's knowledge?

Dr. Collins gave a hint of a smile, knowing Karen was annoyed, and then glanced at Dean, noticing he was sitting on the bed with Sam – and knowing he should tell him to move – but thinking better of it.

He directed his attention back to the phone. "Gentlemen, I'm Dr. Collins, and I've been taking care of Sam since he's been here."

"How's my son?" John asked, leaning his forearms against the truck's hood, tilting his ear closer to the phone as another 18-wheeler passed.

"He's a tough kid," Dr. Collins responded, smiling proudly at his patient. "He's been through a lot over the past few hours, but he's holding his own right now."

Dean squeezed his brother's hand. _That's my boy,_ his heart rejoiced. _Kick this in the ass, Sammy._

"They said you took his spleen?" Bobby questioned, his gruff voice making his tone seem accusatory, as though next he would demand it be given back.

"Yes," Dr. Collins responded. "We had no choice. Sam's spleen was enlarged and wasn't clotting itself as expected. In fact, his spleen was so enlarged that we were unable to remove it laparoscopically, so we performed an open splenectomy, meaning there's a larger incision and more stitches. We also placed a drainage tube to temporarily drain any accumulated fluid or blood, but we expect to remove that in the next 24 hours."

Dean nodded, eyes scanning Sam's bandaged torso even though he had already noticed and checked the surgeon's work prior to Jim arriving in the room.

"In retrospect," Dr. Collins continued, "we probably should've performed surgery upon Sam's admittance to the hospital, but we didn't realize how massive the trauma was."

Dean frowned. "Meaning?"

Dr. Collins sighed. "The ultrasound showed a small tear anteriorly but failed to show a much larger, more catastrophic tear posteriorly. It makes sense now why Sam's vitals wouldn't stablize and why his condition continued to rapidly decline. His body was dealing with severe hemorrahging and drastic blood loss. It's truly amazing that Sam is still alive."

Silence followed, punctuated by the cadence of the ventilator and monitoring equipment. Jim glanced at Dean as Dean stared at Sam. John and Bobby said nothing, the hum of the open phoneline and the shuffle of boots on gravel the only indications they were still there.

"So..." Jim began, swallowing against his dry throat, preparing to ask the question they all wanted answered. "Now that his spleen has been removed and the bleeding is under control, Sam will start to recover?"

"Ideally, yes."

"Ideally?" Dean and John simultaneously snapped.

"What the hell does that mean?" John demanded, and Dean's sharp glare did the same.

Dr. Collins shifted. This was the hard part of the explanation. Patients and their families tended to think that surgery was magical, assuming all would be fixed following the procedure. But it rarely worked that way.

"While Sam is no longer losing blood, he _is _dealing with the blood he has lost." The doctor glanced at one of the bags hanging above his patient's bed. "Sam was given FFP during surgery to help with coagulation and is now about halfway through his second blood transfusion. I'm thinking he'll need at least one...maybe two...more, but we'll see how he responds before making that decision. We're also going to keep him heavily sedated for now and probably for the next couple of hours so that he will rest and won't fight the vent."

"When will you remove that?" Dean asked, knowing how much Sam hated it, how much his independent little brother hated having things forced down his throat...literal or otherwise.

"As soon as possible," Dr. Collins responded. "Due to the splenectomy, Sam is already at a higher risk to sustain a pneumothorax, so I don't want to tempt fate. Plus, there's the risk of ventilator-associated pneumonia, so as soon as Sam is able, we'll extubate." He paused. "Also, in addition to recovering from the blood loss and surgery and coming off the vent, Sam needs to bounce back from the acute renal and liver faliure as well as the ARDS."

"Whoa, whoa, whoa...renal and liver failure?" John asked, his heart in his throat. "And what the hell is ARDS?"

"One thing at a time," Dr. Collins patiently responded. "Due to the massive blood loss, Sam's organs were beginning to shut down, hence the renal and liver failure. But both were in the acute stages, so there's a good chance they can both be reversed. As for your other question...ARDS is acture respiratory distress syndrome, which effects Sam's breathing and – "

"Then why are you taking Sam off the ventilator?" John interrupted.

"Because it isn't worth the risk to leave him on it if we can maintain his O2 sats with an oxygen mask." Dr. Collins paused. "Any more questions?"

Jim felt the pressure of anxiety in his chest. Sam had so much to overcome. "What's the prognosis?"

"Guarded," Dr. Collins answered simply. "Needless to say, we'll be monitoring him closely over the next 24 to 48 hours."

Dean and Jim exchanged glances, absorbing the information.

"So even though he's come a long way, the kid still has a fight ahead of him."

Dr. Collins nodded at the sound of Bobby's voice. "Yes. Absolutely."

"Story of our lives..." Dean commented quietly and saw Jim smile sadly in response.

A sudden loud beep directed four pairs of eyes to Sam.

"What's that?" Dean asked, alarmed.

Dr. Collins glanced at Karen and shook his head. "I don't – "

"What's going on?" John demanded.

The beep came again, not from anything hooked up to Sam, but from the phone Jim held.

Jim sighed as Dean briefly closed his eyes in relieved realization, before taking the phone from the Pastor's grasp.

"Just the phone. It's losing its charge. We'll see you when you get here," Dean said bluntly, ending the call and powering off Jim's phone.

Jim arched an eyebrow. He could imagine John Winchester's reaction to the abruptly ended call, battery issues or not.

Dean shrugged – it was the least of his worries...did the Pastor forget his earlier exchange with his father – then directed his attention back to the doctor.

"So, what now?"

Dr. Collins sighed. "Well, our primary concern is the next 24 hours. We'll be monitoring Sam closely, keeping a check on his vitals, of course, but also on the incision and drain tube."

"When will you remove that?" Dean asked, reminded of a bad experience John encountered with one of those a few years back. "They're breeding grounds for infection."

"They certainly can be," Dr. Collins agreed. "But this drain is inserted away from the primary incision to help prevent transmission of infection between the operation site and the exit site. They can be dressed and managed separately, and Karen will keep a close watch."

Karen nodded. "We won't leave it in place a second longer than it's needed, I promise."

Dean knew she meant well but wasn't soothed; experience had taught him not to believe anyone's promises but Sam's.

"When will Sam be out of recovery?"

Dr. Collins glanced at Jim. "Barring any complications, we're planning to move Sam back to his room in the Intensive Care Unit within the next hour or two. We'll then decrease his sedation, wait for him to wake up, and start weaning him off the vent. As I said before, the sooner we can get him off, the better."

"Whenever you're ready, Sam will be ready," Dean assured. "He hates that thing."

"Yes, I gathered that." Dr. Collins chuckled, thinking that was an understatement given Sam's violent reaction when he first regained consciousness. "If it wasn't for you being here to soothe and distract him long enough for us to further sedate him, I'm sure he would've removed it himself earlier." He turned toward the door. "Well, I have other patients to see. I'll check on him later, but if you have any questions or concerns before then, ask Karen or have her page me."

Dean nodded, hearing rather than seeing the doctor and nurse leave the room as he continued to stare at his brother.

"Well..." Jim sighed, the relief and hesitant hope they both felt summed up in one word.

"Yeah," Dean agreed and swept his brother's bangs aside, pleased that Sam didn't feel as warm as he did earlier. "Keep fighting, Sammy. So far, so good."

_**TBC…not sure when**_

_**FFP = fresh frozen plasma**_


	15. Chapter 15

"Well," Karen sighed, her gloved hand gently skimming the incision exposed by removed gauze and blankets folded down to her patient's slim waist. "Looks like you're right."

Dean said nothing, standing behind her, arms crossed over his chest. He hadn't called her into his brother's room to hear her tell him that he was right; he knew he was right. Their dad might be a selfish, inconsiderate asshole, but the man knew his first aid, had taught his sons well. And Dean knew the signs of infection when he saw them.

"When did you notice this?" Karen asked, glancing at him.

"Just now."

Karen nodded, briefly wondering what made Dean check his brother's incision since she had done so herself less than an hour ago and had noted no problems. And then she remembered, smiling to herself at the sudden clarity of the answer – she was dealing with one of the most protective, vigilant older brothers she had ever encountered...and that was why Dean had checked. Keeping an eye on Sam was just what he did.

Karen's smile lingered as she wondered if these boys knew how special they were, how priceless their relationship was...and then she blinked, noticing Dean's scowl of impatience.

"He's definitely got a nice little infection going on here," she commented as she refocused and continued her examination. "The redness, the warmth of the incision, the swelling and slight hardening from the inflamed tissue underneath..." Karen shook her head, checking the drain tube. "No drainage, though."

And wasn't that strange? There had been excessive drainage an hour ago when she had checked, recorded, and changed the dressing...and now there was nothing?

"Because the damn thing's probably clogged," Dean snapped and knew Karen's sigh confirmed it.

"You're right," she said anyway and sighed again.

"Shit," Dean hissed.

"At least he's already on antibiotics," Karen reminded. "But since the tube is occluded and no longer beneficial, I'll remove it and then call Dr. Collins to see how he wants to proceed."

"It never should've been placed," Dean ranted. "I told him it was a bad idea, that something like this could happen."

"That's always a possibility," Karen agreed, turning to face him. "But it was necessary to drain fluid which may have accumulated and in itself become a focus of infection."

"Or get clogged and allow infection to accumulate anyway."

Karen paused, realizing she wasn't going to win this battle. "I know you're upset, and I know it's the last thing Sam needs right now, but at least we know this infection has only been building over the past hour. We've caught it early."

"Super."

"Dean – "

"Enough talking," Dean stated flatly. "Are you gonna remove it, or am I?"

Karen smiled and almost laughed until she realized he wasn't joking. If given the opportunity, Dean would remove the drain tube himself. She was probably lucky he hadn't already done so and just told her about it later.

Dean stared at her.

"Um...I will."

"Then do it before he wakes up."

"We have time," Karen assured. "His sedation has been decreased, but we still have at least an hour or so before he starts to stir."

"We have about 20 minutes," Dean corrected, having moved to stand beside Sam's bed.

Dean's eyes instinctively scanned his little brother, noticing the way the kid's fingers minutely twitched and how the muscles around his eyes tensed, which was about as close as they were going to get to a waking-up-Sammy face scrunch since the breathing tube was still in place.

Karen narrowed her eyes, glancing from Dean to Sam and back to Dean.

"Twenty minutes..." Dean repeated and then paused as Sam's leg moved. "Maybe less."

Karen continued to stare at him. Experience told her that timeframe was incorrect, but then again...no one knew Sam like Dean.

Dean nodded, seeming to read her thoughts. "Trust me."

Karen laughed lightly, amusement overriding her annoyance at being bossed around by her patient's big brother.

"Fine," she conceded, fingers grasping the cuffs of the gloves at her wrists and pulling, folding them inside each other and dropping them in the trashcan before washing her hands. "I'll go gather a few supplies and be right back," she said, drying her hands and exiting the room.

Dean nodded again, staring down at his little brother. "Nothing's ever simple with you, is it kiddo?" he asked softly, slipping his hand under Sam's bangs, feeling a drastically warmer forehead than he had felt two hours ago downstairs in recovery. "Ah, Sammy..."

"What?" Karen asked, reentering the room with a canary yellow basin filled with towels, a washcloth, gauze, tape, swabs, and a smaller tray along with Sam's chart tucked under her arm.

"His fever's up," Dean reported, turning to the sink to wash his hands and watching as she placed the items on the bedside table and then came to stand beside him, filling the basin with water.

"I'm not surprised," Karen commented, carefully setting the basin on the table, feeling the warmth of the water through its plastic sides. "It's time for me to check and record his vitals again, so as soon as I'm finished with this, I'll do that."

"I'll do this," Dean corrected, drying his hands and snagging the washcloth and towel from her grasp. "You do that."

"Do what?"

"His vitals."

"You sure?" Karen asked, more out of habit than necessity.

Dean didn't respond, already spreading the towel across Sam's lap.

Karen sighed, having her answer. She pulled two gloves from the box on the wall.

"Want some?" she asked, wiggling her fingers into their respective slots, stretching and adjusting the blue nitrile over her hands. "I know Sam's your brother, but universal precautions and all that..."

Dean snorted.

Karen stared at him unwaveringly.

"Dude...seriously?"

Karen held out a pair of the blue gloves. "Seriously."

Dean continued to stare at her.

Karen rolled her eyes. "Fine. If not for your safety, then do it for Sam's. We need to keep everything as sterile as possible."

After a few seconds, Dean sighed and took the gloves, even though he hated the damn things. They never fit his hands correctly and made him feel like he was all thumbs, but – and Karen probably knew this, the manipulative bitch – he would do anything for Sam.

"Happy?" Dean asked sarcastically, wanting to feel irritated but not quite managing. He couldn't fault anyone who put Sam above all else.

"Ecstatic," Karen replied, her tone blunt but her eyes shining.

Dean gave a hint of a smile, appreciating the moment of banter with a cute nurse, but then turned to Sam.

Break was over. He was back on duty.

Karen smiled, noticing the subtle change in Dean's demeanor but then felt it slip from her face when she noticed him preparing to remove the tube.

"Whoa!" Karen's hand immediately grasped Dean's wrist, and then she laughed nervously, not sure who was startled more by the action. "Sorry," she apologized, glancing up at Dean and releasing her grip at his pointed stare. "But let me at least do that part."

Dean arched an eyebrow. "Why?"

"Because administration would freak if they found out I let a patient's family member remove a drain tube." She shook her head, almost shuddering at the thought of how much shit would hit the fan if that happened.

Dean seemed amused at her reaction but didn't back away from his brother's side, forcing her to contort her body and lean in front of him at an awkward angle.

Karen sighed, setting the small tray in Sam's lap and wondering if Dean knew that his protective nature was becoming a pain in her ass.

"Don't hurt him," Dean warned as her maneuvering of the tube caused Sam to shift on the bed.

"I'll try not to," Karen promised, a little surprised that Sam was close enough to consciousness to feel her handling the drain. Maybe Dean was right when he said his little brother was close to waking. "There we go..." she said, slowly sliding the tube out, and then wrinkling her nose at the smell that came with it. "Well, that's not good," she commented as she placed the bloody milky-white tube on the tray.

"No shit," Dean stated bluntly, pushing her aside in order to inspect the incision himself, alarmed but not surprised at the thick, blood-tinged, yellowish-white pus that oozed from between the stitches. "Sonuvabitch."

"I've paged Dr. Collins," Karen assured, knowing it wasn't much but feeling the need to say something. She removed the tray and quickly swabbed the incision, bagging the sample to send off to the lab before removing her gloves.

Dean said nothing, dipping the washcloth into the basin's water, twisting it tight to wring out the excess, then even tighter to relieve some of his stress.

Karen sighed in the silence that settled between them and grabbed Sam's chart from the table, crossing to the other side of the bed as she flipped through the pages and began writing down information from the monitors.

Dean's brow creased with the intensity of his focus as he gently cleaned Sam's incision; dabbing gauze to collect the drainage; then wiping away the dried blood, the crusted pus, and the sticky yellow surgical disinfectant. His touch was light as his fingers skimmed the bluish-purple skin puckered by the dark stitches. His gaze tracked the red streaks of infection that webbed outward as his palm hovered over the incision, feeling the warmth.

Dean sighed harshly, worried and pissed that Sam had to endure yet another setback.

Karen glanced at him, feeling his frustration and thinking they both could use a distraction. "Where's your uncle?"

"Who?"

"Your uncle...the Pastor."

"Oh." Dean nodded to himself. Of course she was referring to Jim. "He went downstairs to get coffee."

Although Dean would bet money he also stopped by the hospital's chapel. It didn't take _this_ long to get coffee.

"I see."

There was more silence, punctuated by the cadence of the monitors.

"And your dad?"

Dean dropped the washcloth into the basin and narrowed his eyes. "What about him?"

Karen flinched at his sharp tone, wondering if she should abandon this topic. But she had already started it, so...

"It's been about two hours since Sam was in recovery, since the phone call, so should he be close by now?"

Dean said nothing as he placed a large square of fresh gauze over Sam's incision.

"He should be here soon, right?" Karen rephrased, squatting down to check the amount of urine gathered from the Foley.

Dean remained quiet, securing the gauze with tape and glancing up as Sam shifted under his touch. "Sammy?" he whispered, snatching off his gloves and tossing them on the bedside table.

Dean felt a hint of a smile when his brother's hand brushed against his as the kid's arm moved restlessly by his side, a delayed attempt to push Dean's hand away from the incision, undoubtedly trying to stop the pain.

Dean's smile widened as he pulled the blankets higher and smoothed them over Sam's bare chest. He then gently restrained Sam's weakly flailing arm and laced his fingers with his brother's smaller ones, feeling an answering pressure as Sam squeezed his hand, responding to the familiar calming touch.

Dean felt ridiculously excited. He didn't want to rush Sam, but he was eager to see those hazel eyes.

"Dean?" Karen prompted, still crouched by the bed, squinting at the catheter drainage bag, trying to get an accurate reading. "I know it's not really any of my business, and I don't mean to pry but – "

"Shut up, Karen," Dean interrupted, his tone neutral yet demanding.

Karen blinked at the unexpected response. "I'm...um..." She paused and then stood. "I'm sorry. I just thought – "

Dean held up his hand to silence her, then glared for emphasis, and it was then that she realized why he wanted her to stop rambling.

Sam's eyes were open.

Not that he was looking at her.

Sam blinked drowsily at Dean, the corner of his mouth twitching as though he wanted to smile at the sight of his big brother...but he couldn't because of the tube that filled his mouth and was shoved down his throat. His eyes widened at the sudden realization as his other hand – the one not intertwined with Dean's – immediately reached toward his face.

"Whoa, dude." Dean instantly grasped his little brother's right hand, placing it back on the mattress, and then lowered his face closer to Sam's. "Look at me, Sam."

Sam's eyes slowly refocused on his brother after being almost crossed from staring at the tube protruding from his mouth. He made a strangled sound – maybe that's what Dean's name sounded like when it was choked out around a tube – as tears suddenly welled in his eyes.

"I know," Dean soothed. "Just calm down."

Sam blinked at him.

"Sam..."

Sam's only response was to once again reach for the breathing tube with his right hand.

And Dean once again intercepted.

"Don't touch," he said, feeling as though he was reprimanding a toddler Sammy.

Sam made another strangled sound, but this time it sounded more pissed than upset, and Dean sighed, suddenly realizing this wasn't going to be as easy as the first time, two hours ago down in recovery.

"They're gonna take it out soon," Dean promised. "But right now you need to leave it alone, okay?"

Sam seemed to consider that option – leaving it alone – and then shook his head violently, legs moving beneath the sheets, right hand squirming in Dean's grasp.

Dean tightened his hold, hating this. "Sam. Stop."

Sam didn't seem to like that idea either, continuing to fight Dean's grip.

Karen watched the struggle, knowing Dean wouldn't want her to physically intervene but feeling as though she should do something. "Do you want me to – "

"No," Dean responded, not even making eye contact with her and further confirming what she already knew – this was between him and his little brother.

In the next instant, Sam's hand broke free from Dean's grasp, and he grabbed the tube going down his throat.

"Damnit, Sam!" Dean yelled, lunging across his brother's chest to recapture the kid's right hand and realizing too late that in doing so, he had collided with Sam's incision on his left side, was leaning up against it.

Sam made a different sound – something between a scream and a sob – as his eyes squeezed shut.

Dean felt his little brother shudder at the intensity of pain that ran through him and then the kid went limp, all resistance instantly gone.

Dean closed his eyes briefly, feeling his heart drop as time stood still.

_Fuck._

Dean sighed, opening his eyes as he lowered Sam's hand from the tube, resting it on the mattress and then releasing it. He slowly straightened to his full height and sighed again. He could hear the monitors' increased tempo; could see Karen in his peripheral; could sense her speechless gaze as he focused on Sam.

Dean lightly squeezed his brother's left hand, the hand he was still holding.

Sam didn't squeeze back.

Dean swallowed, simultaneously wanting to cry and scream. "Sammy?"

Sam's eyes were still closed, but at the sound of his name, tears slipped through his lashes, silently sliding down flushed cheeks.

Dean felt something twist inside his chest. "Hey. It's okay," he soothed, fingertips gently brushing his little brother's cheeks, then his forehead. "I'm sorry, Sammy. You know I would never hurt you."

For several seconds, Sam didn't respond; then he nodded weakly, his eyes still closed, pain still pinching his features.

Karen moved closer to check one of the monitors, drawing Dean's attention, and he sighed as she did when he noticed Sam's heart rate was returning to normal.

"He's okay," she assured quietly. "Just a wave of shock from the pain, but he's leveling out."

Dean nodded as his thumb rubbed the frown between his brother's eyes, waiting for the kid to look at him, feeling inexplicably desperate and helpless. Dean knew it was ridiculous, but Sam's continued denial of eye contact made him feel rejected by his little brother – and that was one of the few things Dean couldn't bear.

Dean swallowed and then sighed. "Sammy..."

Sam made a sound – so soft it was barely audible – but Dean heard it and knew the meaning behind it, took it as the reassurance it was intended to be. Sam wasn't shutting him out; he was just pulling himself together.

Dean nodded – relieved more than he would admit – and continued to wait, providing comfort and love as his thumb still gently swept across Sam's forehead, as his hand still firmly clasped his brother's small hand.

A few seconds later, he was rewarded when Sam opened his eyes, still glistening with unshed tears, and weakly squeezed Dean's hand, complete absolution given with the twitch of small fingers.

Dean smiled, wondering if his little brother knew just how much he loved him.

"You gonna be still now?" Dean teased.

Sam glared weakly, jarring loose a few remaining tears.

Dean laughed, lightly thumbing away the moisture. "You okay now?"

Sam nodded, looking exhausted as he blinked up at Dean.

Karen cleared her throat, not wanting to interrupt – secretly cherishing this tender moment between the two brothers – but needing to know. "How's his incision?"

Dean glanced at Karen as she came to stand behind him and then once again folded down the blankets to Sam's waist, exposing the dressing covering his brother's left side. Dean sighed, not surprised by the red stain that had blossomed there or by the fresh wave of guilt that swept over him. He peeled back the layers of gauze to reveal one busted stitch at the corner of the incision allowing more blood to flow with the steadily oozing pus.

"Shit," Dean hissed, shaking his head. "I'm sorry, Sam."

Sam squeezed his hand in response. _It's okay._

Karen seemed to agree. "It could be worse," she said, grabbing a fresh pair of gloves and then passing clean gauze to Dean. "At least it's already starting to clot. Good thing he had the FFP and transfusions..."

Dean nodded as he dabbed away the last remnants of blood, feeling Sam flinch and then hearing him grunt. "Almost done, Sammy," he soothed, inspecting the incision more closely.

"Even though one of the stitches busted, I think it'll be fine for now," Karen stated. "At least until Dr. Collins gets here..."

Dean nodded in agreement, covering the incision with several layers of fresh gauze. "What do you think he'll do to treat this?"

"To treat the infection?" Karen shrugged. "Hard to say. He might just want to monitor for the next few hours and increase Sam's dosage of antibiotics or change antibiotics altogether or put Sam on a combination of antibiotics. Or he might want to reopen the incision and clean it out. Or..." She shrugged again. "I don't know. Guess we'll see."

There was silence as Dean pulled the blankets over Sam, noticing his little brother's eyes were closed but knowing the kid wasn't asleep...at least not yet.

"Hey, Sam..."

Both brothers looked at Karen as she moved to stand at the foot of the bed. She flinched at Dean's unexpected scowl of disapproval – probably for disturbing his brother's rest – but she continued anyway.

"Now that you're awake, how 'bout we start weaning you off the vent?"

Sam stared at her as though she was speaking a foreign language.

Karen narrowed her eyes. Was he okay?

"Sam?"

Sam blinked at her.

Karen shifted. "Um..."

"It's okay," Dean assured, smiling softly at his brother, recognizing the signs. "He gets this way when he's tired." He winked at Sam. "Don't 'cha, Sammy?"

Sam looked at him, his eyes dipping closed as his hand slackened in Dean's grasp.

"Well, he certainly has the right to be tired," Karen conceded, feeling a little more at ease after that explanation.

"Yeah, he does," Dean agreed, staring at his brother, affection in his tone.

"Maybe we should wait until later..."

"And have a repeat of what just happened?" Dean shook his head. "Hell no."

Karen laughed lightly. "Good point, but..."

Dean shook his head again as he gently nudged Sam's arm. "Hey."

Sam opened his eyes.

Dean smiled. "Getting you off this vent sounds pretty good, huh?"

Sam made a sound – how an enthusiastic "yes" comes out when choked through a hallow tube – and squeezed Dean's hand for emphasis.

"Awesome. But you need to stay awake, okay?" He gently rubbed his brother's chest, trying to help rouse him. "After we get you off this thing, then you can sleep. Deal?"

Sam squeezed his hand again and made a visible effort to open his eyes wider.

"That's my boy," Dean praised softly, ruffling Sam's hair.

Karen felt her heart swell as she watched the brothers interact, thinking it was probably unhealthy how attached she had become to these two in such a short time.

"Alright," Dean said, looking at her. "Let's do this."

_**TBC**_

_**I'm amazed at how this story just keeps growing, one thing truly leading to another. This chapter was almost 30 pages long, so I decided to cut it in half. Anyway…expect John's arrival and Sam's weaning to be in the next chapter, along with more drama and yet another complication.**_


	16. Chapter 16

"Look who I found in the hall," Karen said good-naturedly, coming back into Sam's room, followed by the lurker.

Dean didn't even have to look to know who had joined them. The aroma of the coffee was a good clue, but he didn't need it; he knew the sound of Jim's approach – a quiet shuffle always followed by a cleared throat when the Pastor entered a room.

Dean smiled and turned, accepting the cup he knew would already be halfway to him in Jim's outstretched hand. "Thanks," was all he said, but he knew...that Jim knew...that he knew the Pastor had made a pit stop by the hospital's chapel.

Jim returned the smile – _message received_ – and shrugged. "Just doin' my job."

Dean arched an eyebrow, always secretly impressed when the Pastor offered a good comeback. "Me, too," he replied and glanced at Sam, who was awake but resting with his eyes closed.

Jim's smile lingered as he nodded, taking a sip from the Styrofoam cup.

Dean did the same, tracking Karen as she moved around the room, washing her hands and grabbing a fresh pair of gloves.

"How's our boy?" Jim asked, also following Karen's movements as she crossed to Sam's bed.

"He's okay right now," Dean responded. "Dealing with an infection and reacted a little...dramatically to the vent when he first woke up, but right now – we're okay."

Jim smiled softly, wondering if Dean realized he had answered in the plural. He probably didn't. With Dean, it was always "we" when it came to Sam; there was rarely an "I" or "him" because they were a package deal. What happened to one, automatically affected the other.

"How bad is the infection?" Jim asked, trying to keep the worry out of his tone.

Dean shrugged, and Jim read between the lines – _pretty bad_.

Jim nodded, mentally adding that issue to his prayer list. "What now? When does he come off that thing?" He gestured toward the ventilator.

"Hopefully right now," Karen answered, turning away from one of the monitors and belatedly realizing that the Pastor wasn't talking to her. She smiled her apology and glanced at her patient, trying to visually determine Sam's level of consciousness.

Jim focused on Karen as she came to stand on the opposite side of Sam's bed and noticed that Dean had moved closer to his brother. Sam seemed to sense Dean's proximity, even with his eyes closed, and instantly reached for his big brother; small hand finding refuge and comfort in a larger hand that was already open and waiting, anticipating Sam's arrival.

Jim sighed, feeling touched – as he often did when he watched the boys interact – and wondering if the brothers even realized how in sync they were.

Karen stared at Sam, determined to figure this out on her own, but then sighed and glanced at Dean. "Is he asleep?"

Dean chuckled lightly – the answer to that question was so obvious – and shook his head, squeezing Sam's hand. "Hey."

Sam opened his eyes.

"It's showtime, Sammy."

Sam blinked at him, trying to regain his bearings.

Dean smiled encouragingly and gently rubbed his brother's chest, helping to rouse and orient him. "Ready to breathe on your own, kiddo?"

Remembrance and understanding ignited in Sam's eyes and he nodded, glancing at Karen and then back to Dean.

Dean returned the nod and then looked at Karen expectantly.

Karen sighed, feeling inexplicably nervous. She had successfully weaned numerous critical patients from a ventilator, and yet she felt apprehensive. What if something went wrong? This was Sam after all...

Dean narrowed his eyes, annoyed by her prolonged silence. "Karen?"

Karen didn't respond.

Dean sighed loudly, becoming wary of her hesitation and pissed by the agitation she was causing in his perceptive little brother. He could feel Sam's muscles tense, could hear the slightly elevated tempo of the heart monitor, could sense his brother's confusion as the kid stared up at him.

"It's okay," Dean softly reassured Sam and then glared more heatedly at Karen.

Jim recognized Dean's expression. "You said you were ready to begin?" he prompted, gracefully intercepting whatever scathing comments Dean was about to hurl in her direction.

Sam glanced at Jim, seeming to just notice he was in the room, and the Pastor smiled softly even as he saw Dean's glare shift to him for the interruption.

Karen blinked and then felt her face flush with embarrassment. "Oh...um...yes," she replied, offering a silent apology with a quick smile. "But before we begin, I want you to know that I've paged respiratory to help with extubation."

"So, we have to wait until they get here?" Dean asked, his tone sharp.

"No, they just need to be present when the actual tube is removed, but while we wait, we'll go ahead and start Sam's SBT with PSV while I monitor his vitals, his RSBI, and – " Her voice faded at the darkening scowl of annoyance on Dean's face. "And I should probably explain what all of that means."

"Probably," Dean agreed bluntly.

Jim cut his eyes at him and sighed. Most of the time, Dean's sarcastic gruffness just made him all the more endearing. But other times – like now – that particular trait made him offensive. "Dean – "

"It's okay," Karen interrupted. "Sometimes I get too wrapped up in my job and forget that others don't really understand what I do."

Dean and Jim exchanged glances. She was preaching to the choir on that one.

"Anyway," she continued. "SBT means spontaneous breathing trial in which Sam will attempt to breathe independently, even though he'll still be connected to the ventilator. PSV – pressure support ventilation – is one of the techniques we use to wean patients from the vent. The ventilator will deliver a set amount of positive pressure into the lungs each time Sam initiates a breath, but he will be able to control the length and depth of each respiration and will be able to breathe at his own rate."

Dean nodded, absorbing the information and feeling Sam's intense gaze, wide eyes filled with alarm and doubt. He squeezed his little brother's hand – _relax...you can do this_ – and then glanced back at Karen.

"And the RSBI?"

"Oh yeah," Karen commented, having forgotten about that...but not surprised that Dean hadn't. "That's the rapid shallow breathing index, which I will monitor along with his vitals. It will help us determine if Sam can tolerate extubation." She paused, not wanting to be Miss-Glass-Half-Empty, but needing to share information on all possible outcomes. "Of course..." she sighed. "Not all spontaneous breathing trials are successful. Sometimes the patient is unable to tolerate the SBT and must be returned to full ventilator support."

Sam's eyes widened, the heart rate monitor attesting to his increased anxiety.

Dean shook his head slightly and squeezed his brother's hand again – _that's not gonna happen...you can do this _– and then glared at Karen.

"Sorry," she apologized. "I'm sure Sam will be fine, but I have to share all the information."

"Of course you do," Jim agreed, glancing at Dean – _tone it down_ – and then smiling at Karen.

Karen returned the smile, thankful to have the Pastor as a buffer. "Any other questions?"

"How long will this take?"

Karen glanced at Dean as she pressed one of the buttons on Sam's bed, raising her patient to sit more upright. "It depends on the patient. Our goal is for Sam to tolerate PSV for at least 15 to 20 minutes and then we'll switch over to CPAP – constant positive airway pressure – for about 30 minutes. CPAP is a final trial of spontaneous breathing prior to removing the endotracheal tube. In this mode, Sam will still breathe on his own but will have the benefit of the ventilator alarms if he has difficulty. If all of that goes well, we'll probably extubate. It'll just depend on Sam and his lungs."

Dean nodded, confident that Sam's years of endurance training were about to pay off. He winked at his little brother and then frowned at Karen.

"What's that?" he asked as she prepared a syringe.

"A sedative," Karen responded, extracting the dosage from the vial, thumping the side of the syringe once, and then slowly administering it to Sam through his IV. "Not enough to knock him out but enough to help him relax a little more."

Dean sighed, torn between being thankful – at least Sam would calm down – and annoyed – he was more than capable of soothing his little brother without the assistance of drugs, thank-you-very-much.

Karen smiled, sensing Dean's internal struggle. "It's part of the protocol when weaning a patient from the vent," she said, hoping he understood that her sedating Sam was due to hospital policy and not because she doubted his big brother abilities.

Dean gave a hint of a smile.

"And this is a bronchodilator," she continued as she administered another syringe. "It should help ease any wheezing that Sam might experience." She dropped both syringes into the red sharps container on the wall and grabbed a long tube. "Okay, sweetie, before we get started, I'm going to suction you."

Sam made a strangled sound of alarm and shifted on the bed, hand tightening on Dean's.

Dean returned the pressure. "It's okay, Sammy. Relax. No big deal." He glanced at Karen, hoping she realized this was going to be a team effort...and he was self-appointed Captain. "Right, Karen?"

Karen nodded, immediately understanding the game plan. "Nope, no big deal at all," she reassured. "I'm just going to inset this suctioning catheter into the endotracheal tube..." She pointed to the tube protruding from Sam's mouth. "And then I'll suction excess secretions into this suctioning canister..." She pointed to a different container on the wall. "And that'll be it. Then we'll start the SBT."

Without further explanation or warning, Karen did just that, smiling softly at her patient. Sam's eyes were closed, one hand grasping Dean's, the other bunching the sheets.

"You're doing good," she praised over the slurping whoosh of the suctioning. "Almost done."

Dean's thumb soothingly rubbed his little brother's as he glanced over his shoulder at Jim, comforted by the Pastor's presence, thankful to have reliable backup, should the situation call for it. Never could tell with Sam.

Jim smiled encouragingly, holding the expression until Dean turned away. He glanced at his watch and inwardly sighed. While he had been downstairs getting coffee – and yes, praying – John had called to say he and Bobby were about 30 minutes away from the hospital.

That had been at least 10 minutes ago.

The Pastor sighed again, crossing to the door and closing it.

Dean's attention flickered to him.

"Just want to give Sam a little privacy..." Jim explained, not mentioning that he also wanted to give them a barrier to John's imminent arrival.

Dean nodded, turning back to Sam as Karen placed the suctioning tube back in its slot on the wall.

"Sam..." Karen waited for her patient to look at her. "I'm about to begin the pressure support ventilation, okay?"

Sam blinked at her and then glanced at Dean, as if seeking reassurance that it was indeed okay.

Dean smiled, knowing his cue. "Sounds good."

Sam stared at Dean for a few more seconds and then nodded at Karen.

Karen smiled, noting Sam's relaxed expression and wondering if it was the effect of drugs...or of big brother. "Okay, now...you may experience some discomfort when you start breathing without the assistance of the ventilator, as you would if you were exercising any other muscle that you hadn't used in a while. But I will continually monitor your vitals and the amount of air you're breathing, and if you start feeling too anxious or start having trouble breathing, we'll stop, okay?"

Sam and Dean nodded together.

"Also," Karen added, glancing at Dean and Jim. "If his blood pressure, respiratory rate, pulse, or EKG indicates excessive fatigue, we'll stop."

"And if we have to stop, how soon can we try again?" Jim asked from his position by the door.

"Tomorrow," Karen replied, accustomed to seeing disappointment at that response but still feeling an extra stab of guilt. "But I'm sure Sam will do fine," she countered, with confidence she didn't feel, as she adjusted the settings on the ventilator.

"Damn right he will," Dean agreed heartily, squeezing Sam's hand.

Sam tightened his grip as well and closed his eyes as he felt a building pressure in his chest. He weakly raised his other hand and pressed against his sternum.

"It's okay, Sammy," Dean soothed, gently removing Sam's hand and resting it back on the mattress. "It'll pass. But let's not add extra pressure with the weight of your hand, huh? It'll get better, just breathe through it."

"Dean's right, Sam," Karen encouraged.

"Just like always..." Dean commented and winked at Karen.

Karen laughed, feeling some of her own tension ease.

Dean glanced back at Sam, seeing his brother's expression beginning to relax. "Better already?"

Sam nodded, feeling Dean brush his bangs from his eyes as he opened them.

Dean smiled. "You're doing good, kiddo. Halfway there..."

Karen began to shake her head – they weren't halfway there, they were just getting started – but stopped when Dean scowled at her.

Oh.

Right.

She got it now. "Halfway there" was more motivating than "hang in there, you've still got a long way to go".

Karen smiled. Guess that's why Dean was Captain of this team.

Dean nodded, seeming to read her thoughts, and looked amused as he settled into his routine of keeping watch over Sam and the monitors.

When 20 minutes had passed with no problems, Karen allowed herself to start to feel excitement. Maybe Sam had finally caught a break, maybe he would soon be extubated, and she would finally hear his voice. He had communicated with her numerous times but always nonverbally, and she was embarrassed to admit how much she wanted to hear him speak.

"Okay, sweetie," she said, smiling down at her patient. "I'm switching over to CPAP now. We'll wait another 30 minutes or so, and if you continue to do well, we'll talk about extubation."

"Awesome," Dean responded, ruffling Sam's hair – and then freezing when he heard it.

In the hall.

Down by the elevators.

Muffled by the distance and the closed door but still deep and demanding.

The voice he would know anywhere.

Dean narrowed his eyes, feeling his heart rate increase. He glanced at Jim and saw the realization on the Pastor's face as well.

"I'll take care of it," Jim assured, turning to leave.

"No, I will," Dean corrected, holding the Pastor's gaze.

Jim nodded, continuing to stand by the door.

Dean consciously rearranged his expression, not wanting to upset Sam, who, between the sedative and the distraction of being weaned off the ventilator, was oblivious to their father's arrival.

And that was good. Sam had enough to worry about right now without adding John Winchester to the list.

"You're still doing really well, Sam," Karen praised, actually meaning it and feeling more of her own anxiety begin to fade. She smiled up at Dean and then frowned. "What?" she mouthed, sensing something was wrong and not wanting to alert Sam, whose eyes were once again closed as he concentrated on breathing.

Dean shook his head and then lowered his face closer to his brother. "Sammy..."

Sam opened his eyes.

Dean smiled affectionately as he felt some of his own tension dissolve. He was always amazed at how something as simple as Sam looking at him – with all that trust and love – could calm him down and help him focus. "You're kickin' ass, kiddo. Totally making this vent your bitch."

Sam made a sound – a weak laugh choked out around a tube – and the corners of his mouth twitched in a smile.

Dean's smile widened and then faltered.

Sam tilted his head. _What?_

"Nothing."

Sam narrowed his eyes.

Dean chuckled. "Nothing you need to worry about right now," he amended.

Sam held his gaze for a few seconds and then blinked, seeming to relax.

"But I need to step out in the hall for a minute, okay?"

Sam wrinkled his nose, expressing his displeasure at that idea.

"I know," Dean agreed. "But I'll be right back. And Jim will stay in here with you while I'm gone." He glanced over his shoulder, not surprised by the startled expression on the Pastor's face. "Won't you?"

The two words were phrased as a question but were meant as a statement.

Jim sighed, hearing the unspoken message and took comfort in the knowledge that at least Bobby would be in the hall to referee if things got physical. "Yes, of course," he replied, coming to stand beside Dean.

Karen shifted uncomfortably, making a conscious effort to keep her focus on her patient and the ventilator, and not the conversation within a conversation that was taking place across from her.

"Be right back," Dean assured, squeezing Sam's hand and the releasing it into Jim's grasp.

Jim's palm pressed against Sam's as his fingers seized the cuff of Dean's shirt, causing the older brother to pause. "Two things..." he said softly, watching Sam's eyes close once again.

Dean arched an eyebrow.

"You're still in a hospital..." – _so keep it down_ – "...and he's still your father..." – _so watch your mouth_.

Dean swallowed a sigh, annoyed by the reminders – only one of which he would try to keep. But he had too much respect for Jim to show his irritation at being treated like a child, so he nodded and felt the Pastor release his sleeve just as John appeared at the door's window.

Dean felt his heart slam in his chest, adrenaline spurring him to hurry because no way in hell was John Winchester coming in this room right now.

In the next instant, he was in the hall, door closed behind him, and face-to-face with his father. His eyes scanned John's injuries, taking in his dad's bruised jaw, black eye, and split lip.

Dean smirked and glanced at Bobby. "Thanks."

"My pleasure," Bobby replied, standing to the left of John.

John ignored them both, continuing to stare at his oldest. "How's Sam?"

Dean didn't respond.

John arched an eyebrow, realizing nothing had changed in the few hours since their phone conversation. He sighed harshly and moved to sidestep around Dean, only to find himself blocked...by Dean.

"You're not going in there," Dean stated bluntly.

"The hell I'm not," John said, his tone sharp. "I want to see Sam."

"Fine, you can see him," Dean agreed. "From out here."

John narrowed his eyes but looked through the window anyway, feeling his heart drop as a lump of emotion rose to his throat. Sam certainly didn't look well. Not at all. Unnaturally pale, uncharacteristically small, unnervingly fragile. His youngest son's eyes were closed as he rested on the bed, nestled in a bank of pillows, surrounded by a tangle of monitor leads and IV lines. John could barely see Sam's face from the tube that protruded from the kid's mouth, and he was suddenly overcome by the urge to hug his son.

John swallowed against the surge of emotion as his attention shifted to Jim, feeling pissed – if the Pastor had watched Sam more closely, they wouldn't be in this mess – and jealous – he should be the one holding Sam's hand, not Jim.

John sighed as he looked to the opposite side of the bed, pleased to see the woman being gentle with his son, but still wondering how she would react to holy water or a muttered "Christo". Had anyone tested her?

"Who's the woman?"

"Karen, Sam's nurse."

John nodded, remembering talking to her on the phone earlier. "Does she check out?"

Dean didn't respond, momentarily startled...then embarrassed...then pissed with himself that the thought hadn't even occurred to him. All this time Karen had been close to his brother, had even been left alone with Sam, and Dean didn't even know for sure that she was safe. He had just assumed...and that was unacceptable, both by his dad's training and by his own standards when it came to looking after Sam.

_Shit._

John nodded again, not even looking at his son, Dean's silence being answer enough. "You didn't think about it," he stated and then sighed. "Fine. We'll do it later."

"Yes, sir," Dean replied before he could stop himself and then shook his head, disgusted by old habits and by how his anger had started to wane. How did his dad always know which buttons to push to manipulate him?

John gave a hint of a smile, pleased that although Dean was as pissed as he had ever seen him, his son was still obedient by default. That was a start.

There was silence as John watched Karen adjust something on a machine and then reach over to Sam's face. "What's she doing?"

"Sam's being weaned from the ventilator right now," Dean reported, observing his father for a reaction.

John's eyes widened slightly at the announcement, the only sign of emotion to cross his face, as he reached for the doorknob...only to have Dean step in front of it.

John cut his eyes at his oldest, glaring. "Dean..."

"You're not going in there," Dean repeated, trying to regain the upper hand.

"I don't have time for this shit, Dean," John snapped. "While you're stomping your feet like a two-year old, Sam's in there, and he needs me."

"You're right," Dean agreed evenly, feeling his anger slowly start to build again. "He's needed you this whole time, and you weren't here. You don't get to show up now and act like father of the year."

John continued to glare his annoyance. "I got here as soon as I could."

Dean snorted. "Give me a fuckin' break."

"Watch your mouth."

"Kiss my ass."

"Dean..."

Dean knew that growled tone, knew his dad was getting pissed and was more likely to kick his ass than kiss it, but he didn't flinch. "You should've come back when I called to tell you about Sam getting his tonsils out."

John sighed. "It was routine surgery."

"That didn't turn out to be so routine – "

" – only because your brother fell and made things worse."

Dean could feel his blood pressure rise. "Are you blaming Sam for this?"

"No, I'm not blaming him. I'm just saying he should've been more careful," John responded matter-of-factly. "And you should've asked more questions and demanded more tests before you let your brother be misdiagnosed and have surgery he didn't even need."

Dean felt his heart slam in his chest. "So you're blaming me?"

"No, not entirely," John replied bluntly. "If I blame anyone for this current situation, I blame Jim. He should've kept a closer watch on Sam. Your brother was Jim's responsibility."

Dean stared at his father, speechless.

John shook his head. "What?"

"You are un-fucking-believable."

"Dean – "

"Sam is not Jim's responsibility, Dad."

"He was during that time period," John corrected.

"Only because you called me away from him, which was total bullshit, since you left as soon as I got there."

"I needed you."

"Sam needed me more, and I knew that – and you knew that – but like the selfish, manipulative sonuvabitch you are, you made me choose because you didn't care what Sam needed. As usual, you only cared about what _you_ needed."

"That's not true," John said quietly, shaking his head for emphasis.

"Bullshit," Dean hissed.

"Dean – "

"You know..." Dean began conversationally, staring at his father as though he was struck with a revelation. "I don't think you even realize you're full of shit. I think you've been lying to yourself and to the rest of us for so long that you just open your mouth and out comes bullshit."

"Enough, Dean," John snapped, his voice louder, his eyes flashing with anger, his hand curling into a fist by his side.

Dean paused, fully expecting his father to strike him – and prepared to reciprocate.

John sighed, trying to rein in his temper, wondering if Dean knew he could press his buttons just as well as he could press Dean's. "Listen – "

"To more bullshit?" Dean interrupted. "No thanks."

"Damnit, Dean! Shut the fuck up and listen to me!"

Dean's eyes widened at his father's outburst, and then he smiled apologetically at a nurse as she passed them in the hall.

She scowled her disapproval but said nothing and entered the room two doors down from Sam's.

There was silence.

And then more silence.

John sighed again. "I know you're upset and pissed – and that's the only reason I'm going to forget we had this conversation – but regardless of what you think right now, I do care about you and your brother."

Dean snorted. "Wow, Dad. Thanks. That makes everything better."

"I mean it, Dean," John said earnestly. "You boys are everything to me."

Dean remained silent for a moment. "Then why do you always choose the hunt over us?"

The truth of those words was like a physical blow, and John felt winded, standing there in front of his oldest, speechless.

Dean nodded slowly. "That's what I thought."

Silence once again settled between them.

Dean was vaguely aware of Bobby still standing in the background, and he glanced in his direction, appreciative of the hunter's quiet support.

Bobby nodded once and then glanced at John.

Dean's focus shifted back to John as well, seething anger slowly dissipating to a hallow sadness as he realized he would never view his father the same way again. The hero was gone, and all that was left was a vengeful, selfish man who routinely chose the hunt, chose complete strangers over his own children, his own family.

And to Dean, that was unforgivable.

Family always came first. Period.

Dean sighed, overwhelmed and startled by the urge to cry, and turned away, preparing to reenter Sam's room just as Jim opened the door.

Dean blinked at the Pastor's sudden appearance and felt his heart drop as he realized he had been in the hall longer than he intended. "Is Sam okay?" he asked urgently.

"He's fine," Jim assured, wondering if the same could be said for those in the hall. Judging by the tension and dark expressions, he would bet not.

"If he's fine, then why are you out here?"

Jim smiled. "Nice to see you too, John."

John scowled. "Answer the question, Jim."

But Dean wasn't waiting for a response. He ducked around the Pastor and entered Sam's room, glaring over his shoulder at John – _stay out_ – as he closed the door.

Karen turned, startled. "Dean?"

"Christo."

Karen frowned but didn't flinch or change eye color. "What?"

Dean shook his head. "Nothing."

Karen smiled nervously. That was...weird.

"Is he okay?" Dean demanded, approaching the bed and then glancing down at Sam, seeing his brother's eyes were open. "Are you okay?"

Sam nodded drowsily and closed his eyes again.

Dean didn't feel soothed. Sam was relatively alert before he left earlier and now his brother could barely keep his eyes open. "Why is he so out of it?"

"He's just tired, but I promise he's fine," Karen responded. "He's still experiencing a little pressure in his chest, but everything looks good overall. We just have to wait for Dr. Collins to make the final decision to extubate and then someone from respiratory will come to assist."

"How long will that take?"

Karen shrugged. "Hard to say. Dr. Collins should be here soon, though." She paused, dreading the next part. "In the meantime, you're going to have to wait out in the hall."

"What? Why?" Dean snapped.

Karen sighed. "It's hospital policy that patients' family members are not present during extubation. That's why I sent your uncle out just now."

Dean stared at her.

"These rooms are small and get pretty crowded pretty quick," Karen further explained. "Plus, extubation can be a little messy sometimes, so it's also for the patient's privacy."

Dean snorted. Messy? Five days ago, Sam had thrown up on him. It didn't get much messier than that. And privacy? There was no privacy between him and Sam; they shared everything.

Karen stared at him and sighed again. "You're not gonna go quietly, are you?"

Dean gave a hint of a smile.

Karen batted her eyes excessively. "Please?"

Dean laughed and shook his head. "Nice try...but no. Bad things happen when I leave Sam."

"You can still see him through the window," Karen countered. "And if there's a problem, I promise I'll call you back in." She paused. "Please, Dean. You know I wouldn't ask you if there was a way around it."

Dean seemed to consider her words as he carded his fingers through Sam's hair, remembering all the ways Karen had bent the rules before. He sighed loudly, hating this. "Fine," he begrudgingly acquiesced. "But I'll be watching at that window, and if the extubation doesn't happen in the next 10 minutes, I'm coming back in...to stay. Period."

"Yes, of course. Absolutely." Karen nodded, hoping Dr. Collins and the respiratory therapist moved their asses. "Thank you," she added, knowing how hard this was for Dean.

Dean didn't respond, giving one last stroke to Sam's hair before leaving the room.

**_TBC on Monday_**

_**As I was editing this chapter, it also grew to almost 30 pages, resulting in yet another cut. Sam's extubation and the reveal of the complication will be in the next chapter, but at least John arrived this time, right? **_


	17. Chapter 17

There was no sight, only sound: the steady clangor of bells amidst the red strobe of candy-striped gates; a brute, subterranean rumble vibrating his rib cage; the chitchat of heavy freight coasting over steel rails spiked into wooden planks; a lonely whistle echoing throughout the sleepy valley; the faint horn of a night train, hauntingly beautiful.

Sam stood in the middle of the train car with his eyes closed for he knew it was too dark to see. The windows were open, and he could feel the night air filtering in, whispering through his hair as it traveled down his neck and licked his bare chest with its delicious coolness.

Which was nice because he was hot.

And his chest hurt.

Sam breathed as deeply as he was able, sensing a pressure he couldn't quite place and yet knew that he had known it sometime before.

He opened his eyes slowly as she stepped out of the shadows, separating herself from the darkness, rising like a demon to claim him. He shrank away as she drew closer, swirling in a mist of shivering moonlight, shrouded in black silk. Her eyes were empty and cold like hard blue steel piercing through him. Her face was uncomfortably close to his; her breath expelled onto his naked flesh, sending icy tendrils through him, the cold growing from inside, numbing and all consuming.

And yet he was still unbearably hot.

And why did his chest hurt so much?

Sam tried to swallow as fear gripped him, constricting his throat, narrowing his airway. His heart raced, and yet he glared defiantly at her, watching a smile slowly curl her thin lips. Her blue eyes shone like the morning sky when it glistened in the sun's rays.

And for some reason, he thought about his mother. Didn't she have blue eyes? He thought she did. Maybe. At least they looked blue in that picture he saw once. He'd have to ask Dean. Dean would know.

Dean.

"Sam..." she called to him, the word like a stone thrown into a hollow pit, a single endless journey into an echoing nothing.

Sam stared at her, afraid and confused, and watched as her eyes narrowed. She looked confused, too – and worried.

"Do you remember me?"

Yes, he remembered her, but she would not be pleased to know why. Pleasure was a sort of oblivion you tended to forget. Pain was remembrance; you did not forget pain – and she had inflicted it upon him.

A while ago, she had stabbed him in the left side...or had she pulled something free?

He couldn't remember that part.

But he did remember the explosion of pain under her hand, and while the sudden pain had dissipated into a dull throb, the constant discomfort was still there.

He sighed.

The faint horn of the night train drifted to him again, and suddenly she was across the train – no...across the room.

Sam blinked.

The train was gone, and he was no longer standing. He was sitting; sitting in a bed he had been in before.

Sam opened his eyes wider, realizing he must have dozed off, and tried to regain his bearings, startled by the reality.

He wasn't listening to the horn of a train but to the shrill whine of a monitor, replaced by a steady hum as she pushed its buttons.

His bare chest wasn't cooled by the night breeze but by the swift movement of people around him; people he vaguely recognized but could not place; people that did not include the one person he was looking for, the one person he wanted.

Sam tried to speak, to call for his brother, but instead choked. He reached weakly for his face and watched as she did the same.

"Whoa, Sam. Wait. I'm going to help you, remember? But you need to relax, sweetheart."

Sweetheart. That was nice. No one ever called him that. Not that he could remember, anyway. Maybe she wasn't so bad after all...

She reached toward him again, her hands searing his flesh, trailing a blaze of fire across his face, sweeping through his hair.

Did she know how hot he was? How much his chest hurt?

Maybe he should tell her.

No.

He should tell Dean.

Dean would understand, would make it better.

Where was Dean?

"Sam..." she called to him again, hand resting on his head.

Sam thrashed on the bed, suddenly desperate to get away from her touch, from the heat that enveloped him, from the invading presence in his mouth, from the crushing pressure in his chest.

Where was Dean?

"Easy, Sam. Calm down."

"Karen..." someone called, and Sam stilled, turning his attention toward the voice.

A voice he didn't recognize; a voice that didn't belong to Dean.

A man materialized beside the woman, tall compared to her. His dark hair was flecked with gray; wire-rimmed glasses perched on the bridge of his long narrow nose. His voice was deep, reverberating in Sam's chest, increasing the already unbearable pressure.

Maybe he should tell this man to tell Dean that his chest hurt.

"Is this his first trial of spontaneous breathing?" the man asked.

"Yes, Dr. Collins," Karen answered. "He's been breathing for about 30 minutes in CPAP mode, with excellent tolerance and no use of pressure support. But he's become increasingly agitated over the last 10 minutes."

"The same could be said for those in the hall," Dr. Collins commented leafing through a folder.

Sam wondered what that meant, wondered who was in the hall. Was Dean in the hall? If so, someone should get him. Someone should bring his brother in the room, so Sam could tell him he was hot...and that his chest hurt.

Really, really bad.

"His fever has also increased, up to 103.3."

Dr. Collins glanced at Karen. "What was it prior to that reading?"

Karen flipped to the front of the folder the doctor still held and pointed.

"A three degree jump in under 10 minutes." Dr. Collins shook his head. "Not good."

Karen shook her head in agreement. "Worsening infection?"

Dr. Collins sighed. "Most likely. How are his other vitals?"

"Blood pressure is a little low, pulse is a little weak, and heart rate is a little fast."

"All signs of anxiety."

Karen nodded. "Like I said, he's become increasingly agitated over the past 10 minutes...ever since his brother left the room."

Dr. Collins arched an eyebrow. "That probably explains it." He smiled and then sighed. "Okay, let's look at his other numbers."

"I haven't had a chance to look at them yet," Karen commented as she turned a few pages in the folder and then pointed again.

Dr. Collins scanned the information and frowned.

Karen's expression subconsciously mirrored his. "What?"

"All his numbers are a little low."

"What do you mean?"

"I mean they're a little low," Dr. Collins repeated, annoyance in his tone. "His vital capacity, tidal and minute volumes, respiratory rate, negative inspiratory force, and arterial blood gas are all a little low."

"Too low?"

"Low enough."

"I don't understand," Karen responded, shaking her head. "He's been doing really well with the SBT. He did well with PSV, and he's continued to do well on CPAP. He's fatigued, but no more than expected, and he hasn't indicated that he's experiencing trouble breathing."

"Maybe he's too stubborn to complain," Dr. Collins commented, gloving up as he looked over at his patient, startled to see Sam staring straight back him. The doctor felt unnerved by the intensity of Sam's gaze, almost like the kid was trying to tell him something. "Sam?"

Sam stared at the man with the deep voice and wondered if he could go find Dean. He was hot, and his chest hurt, and he really wanted Dean.

Dr. Collins approached the bed. "You okay, Sam?"

Sam pressed his hand to his chest in response.

"He's been doing that since we started," Karen reported.

Dr. Collins nodded. "A little chest discomfort is common when coming off the ventilator, Sam. It'll get better once we extubate and you breathe more on your own."

Sam stared up at the man with the deep voice, wondering why he didn't understand what was so obvious; wondering why he was there, but Dean wasn't.

Dr. Collins smiled as Sam continued to stare at him and quickly checked the kid's incision, noting the red lines of infection peeking out from under the gauze and shook his head. Even after all the medical advances, infection was still a doctor's primary enemy.

"While I'd like for his numbers to be a little higher, let's go ahead and suction him and prepare to extubate. We'll give him about an hour to breathe on his own with an oxygen mask to assist, and then I'll be back."

Karen nodded. "What about that?" she asked, pointing at Sam's incision.

"Let's maintain current dosage of antibiotics and then revaluate in an hour." Dr. Collins discarded his gloves and washed his hands. "Have you paged respiratory?"

"Yes," Karen replied, staring at Sam and feeling her earlier anxiety return.

Was he trying to tell them something? Maybe she should get Dean...

She sighed and shook her head at herself.

No.

If she called Dean in now, she'd never get him back out. Besides, she was being ridiculous. Sam was fine; he was just uncomfortable and tired from the SBT.

"Karen?" Dr. Collins prompted.

Karen blinked. "Yes?"

"I asked if you've page respiratory."

"Oh...um...yes," Karen replied, willing herself to relax. "I asked Ashley to come up..."

"And your wish is my command," said a voice from the door.

Sam watched as another woman entered the room and approached his bed. She had short blond hair pulled back in a high ponytail and wore a white long-sleeved shirt under green scrubs.

Had she seen Dean? Maybe she could go find his brother and bring him in the room; so Sam could tell him about his chest pain; so Dean could make it better.

"Thanks for coming, Ash," Karen said, accepting the folder from Dr. Collins.

"Yeah, yeah," Ashley responded, smiling as she waved her hand dismissively before grabbing a pair of gloves from the box on the wall. "I almost got attacked in the hall, though. I think his family is getting restless."

Dr. Collins exchanged knowing glances with Karen. "I'll go do crowd control while you two extubate," he said as he turned toward the door.

"Good luck," Karen teased good-naturedly, setting the folder on the bedside table.

"Thanks," Dr. Collins replied dryly, stepping into the hall.

Ashley approached the bed and stood beside Karen. "Are we ready?"

Karen nodded. "Yep. Dr. Collins just gave orders to extubate."

Ashley returned the nod, eyes scanning their patient. "He's a cutie."

Sam glared at her, wondering if she would still think he was cute when his chest exploded from the building pressure within.

He closed his eyes, fighting the urge to cry.

Where was Dean?

Karen smiled at Ashley. "He's definitely a cutie," she agreed. "And sweet, too. Aren't you, Sam?"

Sam opened his eyes and pressed his hand to his chest once again, hoping they would finally get a clue.

They didn't.

Karen gently moved Sam's hand back to the mattress and reached for the suctioning catheter on the wall. "Alright, sweetheart, let's suction you, okay?"

Sam shook his head slightly.

No.

Not okay.

Dean wasn't there, and nothing was okay.

He shifted restlessly on the bed, feeling crowded by their close proximity and reaching hands.

"Relax, Sam," Karen soothed, suctioning the endotracheal tube and then Sam's mouth as Ashley loosened the fasteners around the tube. "Almost over."

"Boy, he's scrawny, but he's feisty," Ashley commented, surprised by the strength with which Sam pushed her hand away.

Karen laughed. "I think it runs in the family. His brother – "

" – is freakin' _hot_," Ashley finished and nodded for emphasis. "Seriously."

Karen laughed again. "Yes, I know. I've noticed. And you should see him with Sam..."

"Let me guess...protective older brother who's a badass to everyone he meets and yet he's incredibly sweet and gentle with his little brother."

"Exactly," Karen affirmed, placing the suctioning tube back in its slot.

"Wow," Ashley replied, passing two towels to Karen. "I think he just got hotter."

Karen grinned, draping one towel over Sam's chest and the other across his lap, noticing the kid staring at her again and wondering what he thought about them discussing his older brother.

Sam listened to the women beside his bed, wondering if they knew how pissed Dean would be if he knew they were ignoring his nonverbal pleas for help.

"Okay, sweetie, this isn't going to be comfortable, but Ashley is going to pull the tube now."

Without further warning, Ashley did just that, pulling out the endotracheal tube in a steady, quick motion, causing Sam to gag and cough. She placed the tube on the towel in Sam's lap as Karen held the other towel to his mouth, collecting the secretions as he continued to cough and gasp.

"It's okay, Sam," Karen assured, rubbing his back with her other hand as she wiped his mouth and chin. "Slow, easy breaths. You're doing good..."

Sam squeezed his eyes shut, wondering if she knew she was a liar, if she knew how far away from "good" he was at the moment.

"D..."

"Shhh," Karen soothed. "Not yet. Don't speak yet, Sam. Just breathe."

"Blood," Ashley noted quietly, glancing at the tube and then at the towel Karen held.

Karen nodded. "He's five days post-op from a tonsillectomy."

Instant realization lit in Ashley's eyes, and she returned the nod. "Damn. Poor kid."

"Yeah," Karen agreed, knowing that the usual sore throat and raspy voice resulting from intubation would increase at least tenfold for Sam. She took out a penlight from her pocket. "Okay, sweetheart, open your mouth for me."

Sam felt the coolness of her hand as it lightly pulled on his chin and opened his eyes.

Karen smiled encouragingly, and Sam did as he was asked, feeling her tilt his head back as she looked in his mouth.

"Huh..." Karen said, confused at what she saw.

Ashley glanced at her. "What?"

Karen shrugged, pulling back and allowing Sam to close his mouth. "There's increased inflammation and edema, but the scabs back there are relatively intact, and there's no trace of blood." She paused. "So if his throat isn't bleeding..."

Ashley shook her head as Karen's voice faded, once again looking at the blood on the tube and the towels and not liking the implication.

Sam glanced between the women. Did they get it now?

Karen shared a look with Ashley. "You're the respiratory therapist. What do you think?"

Ashley shrugged. "Hard to say. We don't want to overreact, so maybe just monitor for the next hour and see if the issue resolves itself?"

Sam stared at the woman with the blond ponytail. Was she serious?

Karen felt uneasy with the wait-and-see option but nodded. "Okay," she agreed and nodded again, trying to convince herself that was a good idea. She sighed and smiled down at her patient. "Okay, sweetie, I need you to say something."

Sam had several "somethings" he wanted to say to them but decided none of that mattered. Only one thing ever mattered to him. He inhaled nosily and then exhaled a shuddering breath. "D'n..."

Karen smiled, feeling her heart swell. "Now, how did I know you were going to say that?"

"These two are too much," Ashley commented, feeling unusually sappy.

"Trust me, I know," Karen said, noticing Sam's left arm protectively curl around his stomach as his right hand clutched at his chest. "Sam? What's wrong?"

Sam swallowed, then winced and coughed, causing him to wince again. "H'rts."

"Probably from the coughing," Ashley suggested.

"And the fact that that his incision is infected..." Karen added. "I'll ask Dr. Collins about increasing your pain meds, okay?"

Sam didn't respond immediately, his eyes searching the room. He didn't need more drugs. He needed his big brother. "Where – "

"Shhh," Karen hushed, already knowing. "We'll get him. You just rest and be quiet for now. Your voice is a wreck."

"Thirsty."

"I know," Karen responded as Ashley removed the soiled towels. "The oxygen you're receiving is humidified, so that will help ease your sore throat for now. We'll wait about half an hour or so, and then I'll bring in some ice chips, okay?"

Sam sighed, not really caring. She could keep her ice chips as long she brought in Dean.

"Sam," Ashley called and waited for him to focus on her. "I'm going to put this on you," she said, placing an oxygen mask on his face.

Sam nodded, exhausted and grateful for the extra help to breathe.

"You need to wear it for at least a few hours, okay?"

Sam stared at the woman with the blond ponytail, wondering idly why she and the other woman asked him "okay" after everything they said to him. He seriously doubted they were asking his permission, so did that mean he looked stupid, like he would need further explanation to understand? If anyone was stupid, it was them for not understanding what he had tried to tell them multiple times – his chest freaking _hurt._

Karen exchanged a worried glance with Ashley as Sam stared blankly at them.

"Sam – "

"'Kay," Sam replied irritably, hoping they would shut up, go away, and get Dean.

Ashley laughed, collecting the endotracheal tube and turning toward the door. "As I said before, scrawny but feisty..." she reaffirmed.

"So it seems," Karen agreed, amused and a little surprised by this side of her patient. "Hey..." she called. "Send Dean in."

"Mmm, my pleasure," Ashley responded in a sultry tone, earning another laugh from Karen.

"Behave," Karen admonished, reaching across Sam and shaking her head as Ashley exited the room.

"Sam's asking for Dean," Ashley reported to the three men standing outside the doorway as she tossed the towels into the soiled linen bin in the hall. "Which one of you is Dean?" she questioned, hoping her feigned ignorance wasn't too transparent.

"I am," Dean responded instantly, invading her personal space as he pushed by her. "Sammy..."

Sam smiled weakly when he saw Dean, immediately reaching toward his brother.

Dean felt his protective streak flare and grasped Sam's hand, noticing his brother's flushed cheeks that attested to the kid's rising fever. "You're burning up, kiddo," he commented, other hand sweeping under damp bangs then down the side of Sam's face.

Sam nodded and leaned into his brother's touch, too-warm cheek cupped by a cool hand. He closed his eyes and sighed, feeling marginally better.

Dean always made things better.

Sam opened his eyes and blinked at his brother.

Dean smiled affectionately and lowered his hand, two long fingers gently pressing around the incision. He sighed harshly. "I still don't like the way this looks, Sammy."

"Dr. Collins took a look at it and said we would maintain current course of treatment with antibiotics, and he would check back in an hour," Karen reported, standing against the wall, giving the brothers their privacy while she wrote in Sam's chart.

Dean narrowed his eyes, having liked Dr. Collins for the most part but now reverting to his original impression of the man – he was a dumbass. Anyone with eyes and half a brain would know this infection was beyond the usual course of treatment.

Dean opened his mouth to speak but stopped when he felt Sam squeeze his hand. He looked at his little brother, not liking the expression on Sam's face. "You okay?"

Sam shook his head and pressed his hand to his chest.

Dean frowned. "It still hurts?"

Sam nodded.

Dean glared over his shoulder at Karen. "I thought you said that would get better."

Sam didn't wait for her to respond. He grabbed Dean's other hand and pressed it to his chest, covering his brother's hand with his own, holding it there.

Dean's frown deepened as he felt Sam's rapid, erratic heartbeat against his palm; the shallow rise of his brother's small chest barely moving his hand.

This was not good.

Dean swallowed, trying to calm his own racing heart, as he sat on the edge of Sam's bed, hand sliding from his brother's chest and coming to rest on the back of the kid's neck.

"Scale of one to ten..."

Sam weakly held up both hands, ten fingers stretched wide before closing and resuming their positions – one hand grasped in Dean's hand, the other resting in the center of his chest.

"Shit," Dean hissed. "For how long?"

Sam opened his mouth to respond, but gasped instead as pain flashed across his face; his hand tightening around Dean's; his other hand pressing harder against his chest as his eyes squeezed shut.

"Whoa. Hey..." Dean said just as the alarms started to blare. "Sammy..."

Karen approached the bed, her attention darting to the monitor. "O2 sats dropped to 82."

"But he's wearing a mask..."

"I know," Karen answered, exchanging worried glances with Dean before setting the folder on the bedside table and directing her attention to her patient. "Sam, do you have chest pain?"

Sam nodded excessively – _now_ she finally got it – before his head lolled to the side, his grip loosening on Dean's hand as the monitors continued their gradually increasing din.

Dean squeezed his brother's neck, his hand. "Sam!"

"Shit," Karen hissed.

"What?" Dean asked frantically.

"It all makes sense now..."

"What does?" Dean demanded.

"Damnit! I should've known..."

"What?" Dean yelled, seconds away from shaking the answer out of her.

"Possible acute PE," Karen responded.

Dean's eyes widened, heart pounding at the fear and panic in her voice, at the increasing unresponsiveness of his brother. "What the hell is acute PE?"

"Pulmonary embolism." She looked over her shoulder toward the door. "Ashley!"

In the hall, Ashley heard her name called from within Sam's room.

"How's Sam?" one of the men asked as she turned toward the room's door.

Ashley glanced at him, wondering first what happened to his face...and second if he was Sam's dad. She could see the resemblance – if she tilted her head and squinted – but she could definitely see the favor in Dean.

Ashley dropped the endotracheal tube into the disposable bag the nursing assistant gave her and tied it off, handing it back to the assistant.

"Didn't Dr. Collins update you?" she attempted to evade, hearing Karen call her name again.

"He started to but got a page and had to leave," the Pastor informed.

Ashley nodded, wondering if Sam's family was religious.

"Ashley!" Karen called for the third time.

"So, how 'bout you tell us..." the third man said, his tone gruff, his appearance grungy. "How's Sam?"

"I'm sure he's fine," Ashley assured, but the words had barely escaped her lips before a deafening series of beeps erupted from Sam's room, followed by a blinking light over his door.

They stood in stunned silence before launching into a flurry of activity, Ashley pushing through the door and then attempting to block entry even as all three men surged forward.

**_TBC…on Wednesday_**


	18. Chapter 18

"Sam!"

"Sir, you have to stay back!" Ashley yelled, struggling to keep John Winchester behind her and in the hall where he belonged.

"The hell I will!" John growled, shoving Ashley out of his way, broad hand splayed across her chest as he pushed her against the wall of his son's room.

Dean turned at the sound of his father's voice. "Dad!"

"Dean!"

Karen turned as well. "Ashley!"

"Karen!"

"Ashley, where the hell have you been? Call code! He's in v-fib!"

"What happened?" Ashley responded in shock, staring at their unconscious patient, vaguely aware of the other two men entering the room.

"I don't know," Karen snapped, as she pulled the CPR release lever on Sam's bed. "Just call code!" she ordered, removing the oxygen mask.

Ashley turned back into the hall, snatching the phone from the nurses' station.

Karen reached for the CPR board to slide under Sam on the bed. But John beat her to it, snatching it from her grasp even as Dean was already rolling Sam on his side, pulling his brother toward himself.

"What happened?" John demanded, his voice low as he slid the board beneath his youngest.

Dean watched as his father positioned the board on the mattress under his brother and then gently settled Sam on his back. "He was having chest pain."

John's eyes narrowed. "For how long?"

Dean remembered Sam's complaints about chest pain before he left the room – and he remembered Karen saying she would call him back in if Sam worsened. So, why hadn't she? If she had been paying attention to his brother, she would've surely noticed Sam's signs of distress. But she didn't. She didn't notice, and she didn't call Dean. Which would imply she wasn't paying attention.

"For how long?" John asked again, his tone impatient.

Dean glanced at Karen, already putting two and two together. "Too long."

Karen felt her heart beat faster at the expression on Dean's face and then startled when someone called her name. She turned, seeing another nurse rush into the room.

"Tina!" she shouted over the continuous blare of the monitors. "Where's Ashley?"

Tina gestured vaguely over her shoulder. "In the hall."

Karen could feel herself losing it. "Alright...fine...um..." She needed to focus. "Get an Ambu bag, and I'll start chest compressions. We need to begin CPR."

"Already in progress," Dean responded, his hands laced together – one on top of the other – and positioned over Sam's chest.

"No, wait – " Tina began, but was unceremoniously pushed to the side by John.

Tina made a motion to stop him, but Karen waved her off. Did the woman have a death wish? "It's okay. Push a milligram of Epi into his IV line."

John tilted Sam's head back, large hand almost completely covering Sam's face as he plugged the kid's nose and blew two breaths into his son's mouth.

"What can we do?" Bobby asked as he and Jim stood on either side of the door.

"The milligram of Epi is in," Tina reported.

"Move those chairs and that table out of the way for the crash cart," Karen instructed the men, pointing at the furniture and then leaned into the hall. "Ashley!"

"They're coming!" Ashley assured, hoping the code team's usual five-minute response time would be enough.

"Page Dr. Collins," Karen replied, ducking back into her patient's room and fighting the urge to sob as she watched Sam's father and brother perform CPR.

She knew it was against protocol for the patient's family to assist in life-saving measures for fear they were untrained and would cause more harm than good, but she also knew this was no ordinary family. These men knew what they were doing, as evidenced by their silent synchronicity.

"C'mon, Sam..." Dean urged, consciously keeping his compressions light – not wanting to crack or break his brother's ribs – even as his own heart hammered inside his chest from this, the most horrifying experience of his life.

One minute Sam was breathing, and the next...he wasn't.

Sam had smiled weakly as Dean had approached the bed, had laced his fingers with his big brother's, and then just like that – Sam was gone.

Dean had watched as pain and panic flashed across his brother's face as Sam struggled to breathe, even with the oxygen mask, and then...nothing.

Sam's face had changed in that vague but unquestionable way that happens when life is no longer present, and Dean knew without a doubt that his own heart had stuttered to a stop as well.

But Sam was sadly mistaken if he thought he was leaving Dean. They had already discussed this once, and the conclusion was the same now as it had been a few hours ago: No. Fucking. Way.

"Don't do this, Sammy..." John quietly begged from the opposite side of the bed, as he mentally counted along with Dean.

Dean glanced up at his father, surprised by the raw desperation, the obvious love in those few words. John Winchester didn't let his guard down for anybody, and yet there he stood, startlingly vulnerable as he begged his youngest to hold on.

John returned his oldest son's gaze, saddened by Dean's surprised expression. Was it really so shocking that he cared what happened to his sons? That he loved them? Sure, he rarely told them – couldn't even remember the last time he had actually spoken the words – but they were all guys. They didn't say such things, especially not to each other.

Besides, actions spoke louder than words, and John had shown them numerous times how much he loved them...hadn't he?

John blew two more breaths into Sam's mouth and was reminded of Dean's question when he first arrived – why he always picked the hunt over his sons.

It was a good question – probably something that should've been asked a long time ago.

He glanced at Dean as his oldest continued compressions.

Too bad he didn't have a good answer.

John blew two more breaths and glanced at the monitors. It had been almost two minutes, and Sam showed no signs of reviving – and that was unacceptable.

"Sammy..." he whispered, lowering his face closer to his son's. "C'mon, kiddo."

Dean glanced at his father again, touched and yet angered. Is this what it took for the mighty John Winchester to share his feelings, to make the right choice – for one of his sons to practically die?

Dean shook his head as he continued compressions. That was unacceptable – and worse...it might be too late.

John felt Dean's stare as he blew two more breaths.

Dean did more compressions.

From the far side of the room, Bobby stared meaningfully at Jim, his jaw clenched tight, and the Pastor nodded in understanding.

_Please,_ Jim silently prayed.

John blew two more breaths.

_I know they don't talk to You..._

Dean did more compressions.

_...because they don't think You listen..._

John blew two more breaths.

..._but please don't take him from them..._

Dean did more compressions.

..._from us._

John blew two more breaths.

_Amen._

"Amen," Bobby murmured, his eyes focused on the Winchesters as Dean did more compressions.

And that's how it went for two more minutes.

Breaths...compressions...breaths...compressions...and still nothing.

"Where the hell is that code team?" Dean yelled.

"Their response time is no more than five minutes," Karen informed uselessly, scanning the monitors for any indication that Sam was reviving.

He wasn't.

Karen felt like sobbing. How many times had Sam pressed his hand to his chest? How many times had he stared at her, expressive eyes pleading for her to understand, to help him? How many times had her own intuition told her that there was a problem, that something wasn't right, that she should get Dean?

Karen watched as John blew two more breaths into his son's mouth and felt herself losing the battle, felt tears well in her eyes. If only she had paid closer attention to her patient, to her own instincts as a nurse. If only she hadn't allowed Sam's seemingly successful wean to lull her into a false sense of security, to make her drop her guard, to let her vigilance slide. If only she had not let Ashley distract her, let herself get caught up in the moment of gossip. Instead of talking _about_ Dean, she should have been talking _to_ him..._about_ Sam. Dean would've known; hell, he _had_ known. He was in the room less than a minute before he knew something was wrong – terribly, terribly wrong – with his little brother.

"I'm sorry..."

For a moment, Karen wondered who had said that and then realized she did – her guilty conscience seeking forgiveness without her permission. She held her breath, wondering if anyone had heard her over the monitors and hoping they hadn't. Sam's family had enough to deal with right now; confessions and apologies could be saved for later.

But then she saw it – Dean, staring straight at her – and she knew that he had not only heard her, he knew why she had said it.

"Sorry for what?" Dean snapped, glaring at her as he continued to compress his little brother's chest. "Ignoring him or not getting me sooner?"

Karen didn't respond, unnerved by his icy stare.

John narrowed his eyes and glanced over his shoulder. "You knew there was a problem?"

Karen remained speechless, thinking such a smooth, deep voice should be soothing, maybe even sexy...not pee-your-pants terrifying. Guess Dean wasn't the only one frighteningly protective of Sam.

Karen swallowed against her dry throat, but said nothing, her silence condemning her more than any verbal admission.

John shook his head, thinking he would be perfectly justified in slapping the shit out of her.

He blew two more breaths into Sam's mouth instead.

"You're lucky they're busy right now," Bobby commented.

And Karen knew he was right.

She was lucky. Damn lucky. Maybe even blessed.

She glanced at the Pastor. Had he said a prayer for her?

Jim stared back, his expression uncharacteristically hard.

Guess not.

Karen sighed. It didn't matter. The damage was done – both to Sam and to the working relationship she was building with Dean, the trust she was beginning to earn, not only from him but from the rest of his family.

Maybe later – when Sam was okay – she would try to make amends. Maybe later – when everyone had calmed down – they would realize she was truly sorry for what had happened on her watch. That is, if they didn't report her to Dr. Collins and have Sam removed from her care.

Karen sighed again.

Another minute of silence passed.

"Dean – "

"No," Dean responded immediately, not even looking at his father.

"Dean..." John tried again.

Dean glanced up, horrified to see the resolved desperation in his father's eyes. John looked like a drowning man reaching for a hand that wasn't there. Only it wasn't him that was drowning; it wasn't him that was slipping away, that was dying; it was Sam.

"No fucking way," Dean growled. "I'm not losing him."

"Dean, I'm not saying we stop. But I know you're getting tired. Let – "

"No!" Dean yelled, pushing John back and blowing two breaths into Sam's mouth himself before resuming compressions.

But his father was right; Dean was tired. His arms ached from exertion and trembled with exhaustion, but there was no way anyone else was taking over.

Sam was his.

His kid. His brother. His everything.

And he always fought for what was his.

Dean glared at John and blew two more breaths himself. "I am _not_ giving up on Sam."

"Neither am I," John replied calmly, a little unnerved by the desperate intensity of his oldest. "But Dean, you – "

"Clear the room!" a man yelled, interrupting John and causing Dean to pause mid-compression as he, three women – all clad in dark green scrubs – and Ashley rushed into the room.

"Finally..." Karen sighed, relief flooding her, washing away her self-pity and doubt and filling her with determination. She may have screwed up – but she was still a damn good nurse and knew how to take care of her patient.

And Sam was still her patient.

"Clear the room!" the man repeated, attempting to maneuver the crash cart around all the people that crowded the small ICU room.

"Now!" Karen ordered, pushing John away as the cart was rolled closer to Sam's bed. "You too, Dean – go!"

"I'm not leaving him!" Dean yelled back. "Especially not with you!"

Karen felt the barb but shook it off. "I'll take care of him, Dean. I promise. But you have to leave."

Dean snorted, continuing to compress his brother's chest.

"Leave – all of you!" Tina shouted, herding Jim and Bobby toward the door, then straining against Dean as he stood immobile.

"Sam!"

"Still no pulse," Karen reported.

"Bag him," one of the code nurses instructed, passing an Ambu bag to Ashley and then nodding at Karen. "Continue chest compressions while we set up the defibrillator."

"You have to leave!" Tina yelled, continuing to push against Dean.

"No!" Dean shouted, jerking away from her touch. "I'm not leaving Sam!"

"Dean – "

"No!" Dean shouted again, glaring at his father as John seized his arm. "You always make me leave him, but not this time." He twisted from John's grasp and stepped toward his brother's bed. "Sam!"

"Damnit, Dean! Let them do their job," John growled, his tone harsh, his grip crushing on Dean's bicep as he grabbed his son again.

John followed behind Bobby and Jim, hauling his oldest out of the room, almost colliding with Dr. Collins as the physician rushed past them.

"Sam!" Dean yelled, snatching from his father's grasp as the door was closed in his face.

Dean stared at the door in silence before, in a fit of rage fueled by all-consuming fear and grief, he turned with startling speed and slammed John against the wall, pinning him there with his arm across his father's chest.

Jim moved to intervene, but Bobby caught his arm and his attention, slightly shaking his head. And although he didn't like it, the Pastor couldn't deny it – this was between them.

John's expression was unreadable, his movements eerily calm and controlled as he swept the arm from his chest and firmly shoved Dean back, eyes narrowing, daring his son to charge him again.

Dean arched his eyebrow in response, considering the challenge.

Harsh breathing and muffled sounds from within Sam's room filled the corridor as father and son squared off under the red light that continued to flash over Sam's door.

"You need to calm down," John warned, even as his own tone was harsh, even as he closed the gap between them, finger pointing in Dean's face, commanding obedience.

But Dean was having none of it. He glared at his father, roughly slapping his hand away and shoving John back, much like John had done to him seconds before.

John's impulse was to react with more of the same – authoritative aggression – but as he prepared to bark another order, he paused.

There.

Shining in Dean's green eyes.

Fear cleverly disguised as defiance.

And for the first time in a long time, John got it.

He wasn't dealing with a disobedient soldier that needed disciplining; he was dealing with a scared kid. His kid. His kid that was terrified of the same thing he was – losing Sam. His kid that reacted to fear and grief in the same way he did – with anger and aggression. His kid that had carried the load by himself for entirely too long, who needed a father, not a drill sergeant, to help bear the weight.

John sighed, feeling some of his own anger and tension slowly dissipate.

"You need to calm down," he repeated, but this time feeling calmer himself; this time keeping his deep voice quiet and steady, knowing it would ground his oldest, would calm Dean more than anything else.

Dean closed his eyes briefly. He didn't want to calm down. He wanted to punch and scream and rant at the unfairness of it all; of losing his mother too early and his childhood too soon; of being haunted by memories of hugs and kisses and laughter and of the man his father used to be but would never be again. It wasn't fair that he remembered; it wasn't fair that Sam couldn't. It wasn't fair that after everything he endured – after all the years of being a good son and a good soldier and a good whatever-else John needed him to be – Dean was still going to lose the one thing that had always made everything else bearable.

"I can't lose him," Dean whispered, horrified to hear the words pass his lips, to hear tears in his voice and to feel warm moisture slip unbidden through the lashes of his closed eyes.

Dean held his breath, refusing to let it hitch in further testimony of him crying like a girl in front his father, in front of fellow hunters. Sam did shit like this, not him.

_Fuck._

Dean lowered his head, keeping his eyes closed, unable to look at John or the others as he waited to be chastised – physically or verbally or both – by his father.

But it didn't happen.

Instead of another rough shove or a harsh tone, Dean felt warm hands gently grip his shoulders, heard an equally gentle tone.

"We won't," his father's voice assured.

Dean paused.

That was...unexpected.

Dean slowly lifted his head and opened his eyes, hastily wiping away fresh tears as they threatened to glide down his cheeks.

John smiled, his expression sympathetic, not judgmental. Dean had carried the load too long by himself and that ended. Now.

"We won't lose him," he stated and shook his head for emphasis.

And just like when he was a kid, when his father could make everything right, could make it true just by saying it, Dean believed him.

Dean nodded, feeling the tears abate just as quickly as they had appeared, feeling some of the despair and anger and stress ease in his chest.

John held his son's gaze, returning the nod, and then roughly patted Dean's shoulder – affection only understood by men.

Dean wasn't sure what had just happened between them, was still pissed at his dad for so many things, was in no way letting John off the hook – but he felt strangely thankful and reassured, felt stronger and calmer...which was good because he had a little brother to see to.

He shook himself – moment of emotional crisis over...at least for now – and crossed to Sam's door, staring through the thin window. "C'mon, Sammy..."

"Charging to 64..." the man in green scrubs warned as Dr. Collins approached the head of the bed.

"Talk to me, Karen," Dr. Collins commanded as he stretched blue gloves over his hands.

"Increased chest pain, shortness of breath, blood on the ET tube and also present in his sputum. His sats dropped suddenly and – "

"All clear!" the man in green scrubs called out, waiting for everyone to back away before placing the paddles on either side of Sam's chest, his small body bucking as the shock ran through him.

"Continued v-fib," Tina reported.

"Continue chest compressions. Karen, push 150 milligrams of Amiodarone. Peter, charge to 128," Dr. Collins ordered.

"Do you want to intubate?" one of the code nurses asked.

"How's ventilation, Ashley?"

"I'm getting good chest rise."

"Sats are 90," Karen confirmed.

"Good," Dr. Collins responded. "Keep ventilating with the Ambu bag, and we'll hold off on intubation for now, especially since he was just extubated."

"One-fifty of Amiodarone is in," Karen said, removing the needle from the port and glancing at the door, seeing Dean and the others watching them through the thin window.

"All clear!" Peter yelled, shocking Sam again.

All eyes turned to the monitors.

"Still in v-fib," Tina said unnecessarily.

"Shit," Dr. Collins hissed.

Dean pounded on the door, his yell muffled by the barrier. "Sam!"

"Doctor..."

Dr. Collins glanced at the code nurse. "Continue CPR. Karen, one milligram of Epi. Peter, charge to 192."

"One milligram of Epi is in."

"Dr. Collins," Ashley called. "We have decreased ventilation."

"Sats have dropped to 75," Karen said.

"Damnit!" Dr. Collins spat.

"Prepare to reintubate?" Tina asked.

"Yes."

"All clear!"

Sam's body jerked at the shock – and then his heart started beating.

"Sinus tach," one of the code nurses stated.

"Better than v-fib..." Dr. Collins commented. "Karen..."

"I've got a pulse," Karen declared, smiling with relief and feeling the tension ease in the room as she gave a quick thumbs-up to those in the hall.

"That's my boy," John and Dean whispered together, both looking startled as they heard the other do so.

Dean gave a hint of a smile as his father winked at him, feeling relieved but knowing they weren't out of the woods yet.

"He is one feisty kid," Ashley commented, smiling over at Karen.

Karen smiled even wider. "Good boy, Sam," she praised, ruffling his hair as she traded positions with the doctor as he prepared to intubate again.

"What's his pressure?" Dr. Collins asked.

Karen glanced at the monitor. "Ninety systolic."

Dr. Collins nodded. "Hyperventilate him, Ashley."

Ashley nodded, doing as she was told and then also stepping aside.

Dr. Collins struggled with the laryngoscope.

Karen felt her smile falter.

"Give me some cricoid pressure," Dr. Collins barked.

Karen did so.

"Damnit..."

Karen swallowed, afraid to ask. "What?"

Dr. Collins narrowed his eyes. "There's too much edema in his throat."

Karen's heart dropped. "Trach?"

The doctor's brow furrowed in concentration as he shook his head. "No, not yet. Give me a minute..."

"O2 stats are dropping again," Ashley reported.

"Shit," Dr. Collins snapped, removing the laryngoscope and backing away as Ashley reapplied the Ambu bag. He sighed harshly. "Alright, we have no choice. Get me a trach kit."

Karen glanced at one of the code nurses, who grabbed the kit from the crash cart and then passed it to her.

John narrowed his eyes, watching the activity within his son's room. "What are they doing?"

Dean shook his head. He didn't know; but it certainly didn't look good.

At John's question, Jim and Bobby approached the door, not wanting to crowd previously, but unable to stand in the background any longer.

"Looks like they're gonna do a tracheotomy," Bobby reported, his words igniting realization in the others.

"You're right," Jim agreed.

"Shit."

Dean glanced at John, his father's hissed curse saying it all.

Dr. Collins hyperextended Sam's neck as Karen draped the area and wiped the skin with an alcohol swab. The doctor positioned his fingers on either side of his patient's neck, identifying the location of the cricoid cartilage and then nodded to Karen.

"Scalpel."

Karen paused, momentarily confused. "No Lidocaine?"

"No time," Dr. Collins responded. "Scalpel."

Karen sighed, feeling Sam's family watch her as she handed the doctor a scalpel, swallowing as he made an incision at the level of the second tracheal ring, making a vertical cut down to the fourth tracheal ring.

Dr. Collins performed a blunt dissection of the midline, finger piercing the membrane, and then passed the scalpel to Karen, exchanging it for an angiocatheter that he inserted between the tracheal rings. He aspirated air into the syringe and nodded.

So far, so good.

"Guidewire," he said and felt the requested material, with its characteristic J-shaped tip, placed in his outstretched hand.

Karen glanced at the door. She hated it when families had to watch this.

"Dilator."

Karen passed it over to the doctor, watching as he dilated the incision over the guidewire. She reached for the tracheostomy cannula she knew he would ask for in a few seconds once the stoma reached at adequate diameter.

As expected, Dr. Collins held out his hand, not even asking this time and yet still receiving what he needed. He gave a hint of a smile – always appreciative of a good nurse and a cohesive team – and placed the cannula within the tracheal lumen before removing the dilator and guidewire.

He glanced at Karen, her cue to connect the ventilator.

She did so and then held her breath as Dr. Collins snatched his stethoscope from his neck, listening intently.

"Good breath sounds bilaterally."

"O2 sats are 89 and rising," Ashley reported.

Karen glanced at the monitors to confirm for herself and exhaled, nodding at the door.

"Jesus..." John said in his own exhaled breath and saw Dean nod in agreement.

"Okay," Dr. Collins began, draping his stethoscope over his shoulders. "Let's move him downstairs for a spiral CT to scan for confirmation of a PE."

"Do you want to start a Heparin drip?" Karen asked.

"No, we'll wait until after the scan," Dr. Collins replied. "I don't want to thin his blood if we don't have to."

"But what if he just threw a major clot in his lung?" Karen countered.

"He also just had surgery and is recovering from massive internal bleeding. I don't want him to bleed out."

"He can survive some post-op bleeding. He's had the transfusions and can receive more," Karen pressed. "If it is a PE, and we don't thin his blood, he could throw another clot."

Dr. Collins seemed to consider her argument. "Alright, but call the blood bank. I want more FFP standing by, and we are not going to Heparinize for more than two hours."

Karen nodded, rushing to open the door as Ashley and Tina checked the monitors and pushed Sam's bed over the threshold and into the hall.

"Sam!" Dean yelled at the sight of his brother, immediately matching pace as he grabbed Sam's hand. "Where are you taking him?"

"Downstairs for a spiral CT," Dr. Collins informed as he walked briskly down the hall.

"Why?" John asked from beside Dean.

"Because we think he may have a pulmonary embolism."

"What the hell is that?" Bobby asked.

"A blood clot in his lungs," Jim responded and shook his head, remembering the outcome for a parishioner who had the same diagnosis about three years ago.

"Exactly," Dr. Collins agreed as he pushed the down arrow button.

Dean swallowed. "And what if that's what Sam has?"

"Then I'll be back to discuss our options," Dr. Collins answered cryptically.

John narrowed his eyes. "Meaning?"

"Meaning..."

Dr. Collins trailed off as Sam began to move restlessly on the bed. His patient regaining consciousness this soon was the last thing he expected.

And yet, in the next instant Sam's eyes snapped open as a harsh gasp and a strangled sound simultaneously tore from his mouth and throat.

Dean immediately reached out to still his brother's movements. "Sammy?"

At Dean's touch, Sam's eyes darted to his big brother, obviously panicked and confused as he continued to writhe, arms beginning to flail.

"Whoa, kiddo..." John said, gently restraining his youngest son.

Sam turned toward his father's voice, his confusion increasing.

John smiled softly. "Easy, Sammy."

"It's okay," Dean soothed, lightly rubbing Sam's chest, wondering which was worse – a tube protruding from his little brother's mouth...or a tube protruding from the center of his neck. He swallowed and forced a smile. "It's okay," he repeated, for himself as much as for Sam.

Sam blinked wide, terrified eyes at Dean, tears breaking free and sliding down his cheeks.

"You're okay," Dean assured, his voice stronger as he gently thumbed the moisture from Sam's face and softly kissed his little brother's forehead.

It was an uncharacteristic, extremely sentimental, sappy, girly gesture – especially with an audience – but Dean didn't give a flying shit. Sam had died – or at least had come pretty fucking close – and now his little brother was back, living and breathing, and Dean would kiss him if he wanted to.

"You had a setback, kiddo," Dean said, his face still close to Sam's, his words only meant for his little brother. "But you're gonna be okay."

Sam blinked slowly. He was fading fast, but his hand twitched as he weakly raised his pinky finger and stared at Dean. _Promise?_

Dean heard the elevator ding as the doors slid open and laughed hoarsely at his brother's gesture – remembering a time when a pinky promise meant everything to his little brother.

Dean's eyes stung with unshed tears as he extended his pinky and linked it with Sam's. "I promise, Sammy," he whispered, his forehead pressed against his brother's. "You just keep fighting, and I'll see you when you get back, okay?"

_Okay,_ Sam agreed, barely squeezing Dean's finger in response as his eyes fluttered shut, and he was pushed onto the elevator.

Dean couldn't help the sense of déjà vu as the doors closed – had it really only been a few hours ago that he had squeezed Sam's hand before the kid had been wheeled off to surgery? And now his brother was being taken away again, in worse condition than before.

John sighed, the force and volume indicating his level of worry.

"God help me..." Jim's voice was quiet, as though he were admitting a horrible sin. "But I don't have a good feeling about this."

"Neither do I," Bobby agreed bluntly.

And Dean knew what they meant – but he also knew his little brother.

He pressed the down arrow button and glanced at his father, startled to see John staring straight back at him.

"He's gonna make it," John stated, not as a hope or a wish or a prayer but as a fact.

"Damn right he will," Dean agreed instantly, nodding and feeling more in tune with his dad than he had in a long time.

Bobby and Jim glanced at each other and then at father and son.

Bobby arched an eyebrow as Jim smiled softly in silent approval at the first steps of a mending relationship. All was not forgotten or forgiven between them – not yet...maybe not ever – but they had to start somewhere.

And leave it to Sam to be the catalyst.

The elevator arrived once again in a series of dings before its doors slid open.

"Gentlemen..." Jim prompted, boarding the elevator and holding the door open as his fellow hunters boarded as well.

John and Dean stood side-by-side as the doors closed, shoulders touching in subconscious solidarity as they went downstairs to wait.

_**TBC…not sure when…probably on Monday. It'll depend on how much time I can sneak in to write during the upcoming holidays.**_


	19. Chapter 19

Silence propagates itself, and the longer talk has been suspended, the more difficult it is to find anything to say.

Such was the case as dawn spilled into the consult room that Sunday morning, pouring soft light through the window as it stretched across the floor.

Dean stared at the clock on the far wall, the minute and hour hands blurring as he focused on the second hand slowly ticking on its journey around the face, unnaturally loud in the quiet room.

It had been a little over two hours since anyone had spoken.

It had been closer to three hours since they had last seen Sam. Since he had coded; and been resuscitated; and then trached; and then whisked off for a spiral CT; and then apparently rushed to surgery – _again_ – and would it fucking kill Dr. Collins or Karen or _somebody_ to tell them what the fuck was going on?

Dean stood abruptly, his chair scraping across the floor like nails on a chalkboard.

No one startled at the movement.

They were hunters, after all. Nothing much surprised them, especially not the actions of each other.

But John did glance at his oldest as Dean began to pace the length of the table.

"What the fuck is taking so long?" Dean demanded to no one in particular. "He said he would be back to discuss options after the scan, and that was three fuckin' hours ago!"

"Dean."

Dean glanced at his father, continuing to pace, wondering if John really thought that tone and that stare would work on him now. At this point, he was well beyond calming down.

"Must not have been time to discuss options," Jim replied reasonably, even as his heart ached in his chest at the implication of such a scenario.

His statement did nothing to ease the tension in the room, and Jim closed his eyes briefly, saying yet another prayer, having lost track of how many he had said over the past three hours.

Bobby sighed harshly as he watched John watch Dean. He glanced at Jim, wondering if the Pastor was praying or meditating or simply resting his eyes. Jim had to be exhausted, as did Dean. Both had been at the hospital longer than he and John, and yet Bobby was already drained...emotionally, physically, and mentally. He could only imagine how the other two felt.

Bobby sighed again and was about to speak when the door suddenly opened.

Dean froze at the far end of the table, registering the doctor's presence, and then surged forward. "How's Sam?"

Dr. Collins acknowledged Dean with a glance as he closed the door behind him but did not speak.

John stood abruptly, his shoulder brushing Dean's. "How's Sam?" he repeated.

"Gentlemen..."

Dean felt his stomach clench.

Conversations that began with formalities in hospitals – and especially in hospital consult rooms – did not end well.

No one spoke. No one breathed. No one even looked at each other.

Dr. Collins shifted under their intense gaze, holding the folder to his chest as though it would protect him from their reaction.

"I must be honest with you," he said, his eyes scanning the small room as though he was trying to decide which was strong enough to bear the brunt of the news.

He settled on Dean.

Dean held his breath, braced himself as he would for a physical punch.

"Sam's had a major setback, and right now – "

"Is he still alive?"

Dean stared wide-eyed at his father, the question having never even crossed his mind; the thought that Sam had lost the fight, that his little brother was gone and not coming back being so unfathomable that it never occurred to him.

But now that John had asked...

Dean turned his gaze to the doctor. "Is he?" he asked urgently, because he had to know.

Sam had to be alive. As long as Sam was alive, Dean could handle anything else. But Sam had to be alive.

Dr. Collins sighed. "Yes. Sam is alive."

"But..." Bobby prompted, hating that there always seemed to be a "but" in their lives.

Dr. Collins swallowed. This part never got easier. "The prognosis is not good."

_The prognosis is not good._

The phrase hung in the air, caught in the thick silence that continued to fill the room.

"What the fuck does that mean?" Dean demanded. "Are you giving up on him?"

"No, not at all," Dr. Collins assured calmly, accustomed to dealing with distraught family members in these tiny rooms with stark walls and hard chairs. "Sam's a tough kid."

"Damn right he is," Bobby agreed.

John narrowed his eyes. "But you're still concerned..."

Dr. Collins nodded, glancing from John to Dean, a little unnerved by the intensity of the older brother's stare.

Jim cleared his throat. "Would you elaborate, please?"

"Yes, of course." Dr. Collins inhaled deeply and pulled a chest film from the folder. "We decided to do a chest x-ray first to rule out pneumothorax and other conditions that sometimes mimic symptoms of PE. But as you can see here..." he said, switching on the wall-mounted x-ray viewer and shaking the wobbly film once to stiffen it before placing it over the light. "There is no pneumothorax, and everything appears to be fine."

"That's good, right?" Jim sought to clarify.

Dr. Collins gave a noncommittal gesture – something between a shrug and a head tilt – and pulled a printout from the folder.

Dean felt dread rise in his stomach. He knew body language, and he didn't like what the doctor's was implying. "What's that?"

Dr. Collins hung the printout on the corkboard beside the x-ray viewer. "This is from the spiral CT, which shows a pulmonary embolism in Sam's right pulmonary artery."

"Which you already suspected..."

Dr. Collins glanced over his shoulder and was startled to see all three of the men standing directly behind him, staring at his finger as it marked the spot.

How did he not hear them get so close so quickly?

The doctor shifted nervously. They were beginning to freak him out. Their silent stealth and intense, unwavering focus gave them an edge he hadn't noticed before; made them seem a little unpredictable, maybe even a little dangerous.

Even the Pastor seemed hardcore.

Dr. Collins shook himself. _Get it together._

"Yes," he answered John. "Sam's chest pain and dyspnea so soon after surgery were indicative of PE, as was the sinus tach shown on the ECG after resuscitation. The spiral CT just confirmed that diagnosis."

John nodded and squinted at the dark blob on the printout. "What caused it?"

"Usually we suspect blood clots originating in the deep veins of the legs from long periods of immobility and then traveling to the lungs, where they get wedged in an artery. But sometimes splenectomy patients are different. The spleen stores almost one-third of the total blood platelets of the human body, and after it's removed, the platelet count increases dramatically. This condition is known as thrombocytosis and may result in abnormal clotting of the blood, which could be life-threatening."

"So the thrombo-whatever caused the PE?" John clarified.

Dr. Collins made a noncommittal sound. "It's possible."

"So what did you do to him?" Dean asked, his tone accusatory.

Dr. Collins glanced at Dean, feeling the heat of his glare. "We took Sam down to angiography."

"Without discussing it?"

Dr. Collins shook his head at John. "There wasn't enough time."

Dean glanced at Jim. The Pastor had been right.

Jim nodded, wishing he had been wrong. "Did you place a filter?"

Dr. Collins arched an eyebrow, surprised. What did the Pastor know about filters to treat pulmonary embolisms?

"I've had parishioners over the years that have had PEs," Jim explained, failing to mention that they had all died within days of their diagnosis.

But all of his parishioners had been ill and elderly. Surely a young strong kid like Sam stood a better chance.

"I see," Dr. Collins commented. "Well, since we suspected PE, we had already started a Heparin drip. But Sam's lowered hemoglobin and hematocrit levels indicated another hemorrhage, which was not surprising given his recent history of internal bleeding."

"Shit," John hissed softly.

Dr. Collins nodded in agreement. "So we reversed the Heparin and gave him FFP to help control the hemorrhage."

"And did that work?" Jim asked hopefully.

"Yes, but we were then faced with a different problem. The body will eventually dissolve a clot on its own through a process called clot lysis, but since the clot was so massive..." He pointed again at the CT printout. "...and since Sam was showing signs of hemodynamic instability, we began low-dose thrombolytic therapy with a drug called TPA."

"And that is?" Bobby prompted.

"Tissue plasminogen activator, which is a clot-busting medication that is most commonly used for patients with myocardial infarction or CVA but can also be given to patients with other issues caused by clots, such as PE."

"Wait..." Dean shook his head. "I thought the Heparin was a clot-busting drug? Why would you stop one and then start another if Sam was bleeding from it?"

"No, Heparin is an anticoagulation drug, meaning it prevents clots from forming. TPA dissolves clots that have already formed."

"Does it work?"

Dr. Collins nodded at John. "Yes, it does an excellent job of dissolving clots – which is what Sam needs – but it also significantly raises the risk of bleeding – which is..."

"...what Sam doesn't need," Dean finished.

Dr. Collins sighed. "Exactly. Starting thrombolytic therapy is usually contraindicated in patients that have just undergone surgery for the same reasons we reversed the Heparin – the increased risk of bleeding – but at that point, Sam's life was in danger, and we had no choice. I assure you we're administering the lowest dose possible and are monitoring him closely."

"Is Karen the one monitoring him?" Dean asked, his tone acidic.

Dr. Collins nodded, wary of Dean's attitude. "Yes, she's with him now."

"I want a different nurse," Dean stated bluntly.

Dr. Collins shook his head, confused. "Why? Karen's an excellent nurse."

"Excellent nurse, my ass! She's the reason Sam coded," Dean accused. "If she had been paying closer attention to my brother, instead of doing God knows what, Sam would've gotten help sooner." He shook his head, clearly disgusted and pissed. "I want a different nurse."

"Well...um..." Dr. Collins faltered, not sure how to respond. "Again, Karen is an excellent nurse, and I can't imagine her neglecting a patient. Symptoms of PE are often nondescript and hard to diagnose until there's an emergency situation. It's just the nature of the condition. And with Sam having just come off the vent, it wasn't unusual for him to present with chest pain or shortness of breath. So..."

"Karen should stay."

Dean cut his eyes at Jim, prepared to argue, but pausing when he saw the Pastor's determined yet compassionate expression.

Jim held Dean's gaze. "She's a good nurse, and she cares about Sam. But she's also human, and we all make mistakes."

"But Jim – "

Jim shook his head, continuing to stare at Dean. "Only she and God know the true nature of her mistake, Dean. And if she was negligent – for whatever reason – she knows it, and the guilt she feels will be punishment enough."

Jim paused, not for effect but for Dean's comprehension, for John's oldest to realize the truth of his words.

Dean narrowed his eyes, desperate to hold on to his anger about this – pissed and wanting someone to pay for what had happened. "So, what...forgive and forget and all that crap?"

"No," Jim answered patiently. "We don't forget experiences that frighten us. But we can forgive and move on."

Dean sighed harshly, hating how Jim always spoke so softly; always handled him so patiently; always knew how to calm and soothe him – even when he didn't want to be calmed and soothed.

Dean glanced at John, wondering why John was just staring at him indifferently and thinking his father should take lessons from the Pastor.

Dr. Collins cleared his throat. "So...about Karen..."

Dean sighed again, because as usual, Jim was right. Karen had been good to them, and he knew she would never have intentionally put his brother at risk.

Jim smiled softly, knowing he had won. "She stays."

Dr. Collins nodded but looked to Dean for final confirmation.

"Fine." Dean gave a hint of a smile at Jim and nodded as well. "She stays."

Dr. Collins glanced at John, knowing the decision had already been made but thinking he should at least make a show of asking Sam's father for his input about his son's care.

John shrugged. He was mildly pissed earlier, but he didn't really know the woman. Jim and Dean had been around her longer than he had. She seemed nice enough and capable enough, and as long as she wasn't a demon or some other supernatural threat, he didn't really have an opinion about her.

"Is that okay with you?" Dr. Collins prompted.

John shrugged again. "Sure."

Dean snorted. His father's active involvement in the decisions about Sam's care was...pathetically detached. As usual.

Bobby shook his head and rubbed his hand down his face. Nothing was simple with this crowd. No wonder he was practically bald and had gray hairs in his beard. He only had so much tolerance for unnecessary dramatic bullshit, and the bastards were draining him dry.

"Now that we've got _that_ settled..." Bobby commented dryly, making sure everyone in the room knew what he thought about the time spent on that particular sidebar. "How 'bout you finish telling us about Sam..."

"Yes, of course." Dr. Collins nodded eagerly, thankful for the help in getting back on track. "After the spiral CT, we took Sam to angiography to place a Greenfield filter."

"What's that?" Dean asked, not liking that none of this had been previously discussed.

"It looks kinda like this," Dr. Collins responded, bending his wrist downward as he cupped his hand and spread out his fingers. "The filter has six legs that are joined at the top, creating a cone shape. It's a common alternative treatment when anticoagulation is contraindicated and will help prevent any more potentially fatal blood clots from forming and lodging in Sam's lungs."

Dean felt his heart rate increase, not liking the phrase "potentially fatal" being used in the same sentence as his brother's name.

"So, it kinda spreads everything out and gives plenty of room for whatever to get through?" Bobby clarified, glancing from the doctor's hand to the film still illuminated on the wall.

"Well...kind of," Dr. Collins partially agreed. "When a clot enters the filter, it's directed toward the center and is trapped in the cone." He demonstrated with his hands, his left moving toward his right and then being trapped. "But the filter is designed to allow adequate blood flow around the captured clot." He removed his left hand from his right's grasp and spread out his left fingers, moving them in a sweeping motion to simulate how blood would flow. "Over time, the natural process I mentioned before – clot lysis – will dissolve the trapped clot, thus preventing it from reaching Sam's lungs and creating another PE in the future."

There was silence as the men absorbed the information.

"So is this why Sam was rushed to surgery?" John asked. "For this filter?"

Dr. Collins nodded. "Yes, it's a surgical procedure."

"Did you hurt him?" Dean demanded, still uneasy about this. He had always been suspicious of surgical procedures, but his recent experience with Sam's unnecessary tonsillectomy had made him even more so.

Dr. Collins smiled softly – Sam's comfort always seemed to be one of Dean's primary concerns – and shook his head. "No. Sam was completely under during the procedure. And while I don't normally like patients to be put under anesthesia twice in such a short time period, it couldn't be helped in this case."

John nodded, understanding but not liking it.

"So, this surgical procedure..." Bobby began, arms crossed over his chest. "What did it involve?"

"Well..." Dr. Collins began, impressed that these men always wanted the details on their youngest, whereas most families just stared at him, too overwhelmed to ask questions. "The filter was placed in the inferior vena cava – or IVC – which is a large blood vessel found in your abdomen that continues up to your heart, inside your chest. During the procedure, a catheter was inserted into the blood vessels in Sam's groin. Sometimes we go in through the neck, but because of the trach, we decided against that." He paused. "A fluoroscope was used to guide the catheter into Sam's IVC, then the filter was inserted through the catheter and into the IVC where it attached to the walls of the vein. The catheter was then pulled out, and the filter was left in."

"Is it permanent?" John asked, wondering about long-term implications.

Dean glared at his father, knowing what John really wanted to know – if this filter would affect Sam's ability to hunt.

"Yes, the filter is typically permanent," Dr. Collins responded. "But it should not cause him discomfort or adversely affect Sam's life."

"He should be able to resume normal activities?" John persisted.

Dean's glare intensified. If John Winchester thought Dean was going to allow him to push Sam right back into hunting again after all of this, his dad was a bigger dumbass than Dean thought.

"No."

The word was spoken with such force and authority, that at first, Dr. Collins thought John had incorrectly answered his own question. But then he realized – as did everyone else in the room – that Dean was the one who had delivered the answer.

John arched an eyebrow. "What?"

"No," Dean repeated, staring meaningfully at his father. "Sam won't resume normal activities."

John's expression hardened. He knew exactly what Dean was saying.

"Actually..." Dr. Collins hesitantly corrected. "The filter should not pose any hindrances to Sam. He should be able to resume – "

"No," Dean said again, not even looking at the doctor. This was no longer a medical discussion.

"Yes, he will," John stated, as though the decision was already made, as though, per usual, he wasn't asking Dean's input, he was just delivering the order.

"No, he won't," Dean countered, his tone just as authoritative as his father's.

"It's the family business," John declared.

"It's bullshit," Dean corrected.

Jim sighed.

Bobby did the same.

And Dr. Collins realized father and son were talking about something over his head.

"This is not up for discussion, Dean," John replied coolly. "I'm his father, and – "

"Give me a fuckin' break!" Dean yelled. "You finally drag your ass here, offer a few words of support, a slap on the back, and you think that fixes everything? You think that makes you a father?"

"Dean..."

"No, Jim," Dean interrupted, glancing at the Pastor and shaking his head, refusing to be calmed this time. "You and Bobby are more of a father to us than he has ever been." He looked back at John. "You suck as a father."

Jim briefly closed his eyes as Bobby glanced at Dr. Collins, giving the physician a sarcastic, humorless smile.

_Welcome to our life._

Dr. Collins blinked, unsure of how to react.

Dean stared at his father. He knew he had cut John deep – though his dad's expression didn't show it – and God help him, but it felt good to cause John the same amount of pain his dad had caused him over the past few days.

John glared, sensing Dean's satisfaction at finally saying what had been brewing for a while.

And Dean glared back, just getting started. "Your priorities have been so fucked up for so long that I don't think you're in any position to make decisions about Sam."

John's expression darkened, explosive anger barely contained. "And you are?"

"Damn right, I am!" Dean responded, eyes flashing vivid green, intense with emotion. "Unlike you, I always put Sam first."

"Is that why your brother is fighting for his life right now, Dean?" John asked, his tone a mixture of taunting sarcasm. "Because you put him first and made the best decisions for him?"

Jim's eyes widened as Bobby's expression hardened, but both had the same internal reaction – _Oh, shit – _and both readied for action.

John knew it was a low blow, a verbal sucker punch to his own son; but wounded pride and hurt feelings loosened the tongue and didn't play fair.

Dean felt momentarily stunned – as if his father had physically struck him – and then he was all movement, enraged and out for blood. "You sonuvabitch!" he yelled, lunging toward his father.

Jim quickly intercepted Dean as Bobby moved to block John's approach, the movements of everyone forcing Dr. Collins into a corner of the small room, pressed up against the door and holding his breath.

The physician had seen family arguments over the years – stress and exhaustion had a way of intensifying emotions and pushing buttons – but this beat all. He was apparently right before; these men were unpredictable and a little dangerous.

And that especially sucked for him because he hadn't told them the worst of the news about Sam.

After a few more seconds of swearing and throwing punches, of yelling and shoving, of chairs scraping across the floor, father and son were separated to opposite sides of the room – Dean with the Pastor, and John with the other one.

Dr. Collins observed the men in the silence that followed, watching as the Pastor slowly released Dean, one hand lingering on the boy's chest, making sure he was truly okay. Dean nodded once and then took a step back, distancing himself from the Pastor but continuing to glare at his father across the room.

John remained expressionless as the other one – his name started with "B" – roughly pushed him against the wall and held him there, undoubtedly in nonverbal warning to back off and calm down. John shook from B-guy's grasp, shoving him back as more nonverbal words were exchanged. B-guy didn't seem fazed, holding John's stare until John looked away first, glancing over at his son. B-guy did the same, first looking at Dean and then doing a nonverbal check-in with the Pastor.

It was confusing and dizzying and fascinating all at once.

"I wanna see Sam," Dean suddenly announced, eager to be with his brother, to check on Sam himself. "Now."

Dr. Collins sighed, wondering how in the hell he was going to tell them the rest of Sam's current diagnosis. "Well..."

"What?" Dean and John asked sharply in unison and then glared at each other from across the table.

After what just happened, neither wanted to be in sync with the other right now and seemed pissed that they couldn't turn off that characteristic.

"Where's Sam?" Dean demanded, taking a step toward the doctor.

Dr. Collins sighed again. There was no easy way to broach this subject. "He's in isolation."

"Isolation?" Dean repeated.

"Why?" John asked, feeling dread rise in his stomach.

"For his protection." Dr. Collins paused. He hated this. "Because a pulmonary embolism isn't the only thing Sam is dealing with right now. In fact, it's the least of our worries."

Dean glanced at John, not surprised to see his father staring straight back, not surprised that their anger had vanished – at least for now – as they once again united for Sam.

"That's unsettlingly cryptic," Jim commented, his tone polite but his expression not. Patience had left the building the instant he had to referee a Winchester free-for-all. "Elaborate, please."

Dr. Collins nodded, feeling his heart rate increase. "Sam has overwhelming postsplenectomy infection – OPSI – also known as postsplenectomy sepsis syndrome."

Dean looked at his father again. What the hell was that?

"That as bad as it sounds?" Bobby asked.

"Unfortunately, yes," Dr. Collins answered. "Because Sam no longer has his spleen, he's at an increased risk of infection, especially during the first two years after surgery. As a rule, children are at a greater risk for developing sepsis than adults. In fact, some children are kept on antibiotic therapy until they are 16 years old to help prevent infection, and all asplenic patients are advised to get a pneumococcal vaccine before surgery. But due to the emergency nature of Sam's situation and his critical condition at the time, he was not vaccinated prior to the procedure. And then the incision got infected and..."

"...and now we're royally fucked," Dean finished blunty, staring at the doctor.

"Well..." Dr. Collins hesitated. Those weren't the words he was going to use, but... "Yes."

"Sonuvabitch!" Dean hissed. "I told you not to use that damn drain tube!"

"I know you don't agree, but it was needed at the time," Dr. Collins countered. "That it became occluded was unfortunate but – "

"What if I kicked your ass?" Dean asked conversationally. "Would that be unfortunate, too?"

"Dean..." John warned, as Jim shook his head, and Bobby chuckled softly.

Dr. Collins swallowed. "I know you're upset..."

"No, I'm fuckin' pissed!" Dean corrected. "First, Sam almost dies because you waited too long to remove his spleen; then he codes and almost dies again because one of your nurses wasn't paying attention to him; and now he's got some kind of massive, life-threatening infection because you didn't take the right precautions?"

Dr. Collins was speechless. It was hard to argue with the truth. He sighed as he looked around the room, taking in the dark – almost threatening – expressions of the men, each pair standing on opposite sides of the table but united in their contempt for him and in their love and protectiveness of Sam.

"I'm sorry," he offered lamely. "I'm – "

"Save it," John growled, taking a step toward the doctor. "What now?"

Dr. Collins glanced at Dean, noticing he had stepped closer as well. "Because aplensic patients have a decreased ability to clear bacteria from the blood and also have lowered levels of immunoglobulin M – a protein in blood plasma that helps to fight viruses – they are susceptible to a host of pathogenic microorganisms. But encapsulated organisims, such as _S__treptococcus pneumoniae _are the most common pathogen implicated in OPSI, and blood cultures have confirmed its presence in Sam's case."

"Strep?" Dean repeated. "I thought Sam didn't have strep."

"He doesn't," Dr. Collins agreed. "Well, not the kind of strep you're thinking of. There are numerous strains of strep, and this particular strain is known to cause various kinds of pneumococcal infections, including sepsis."

"How do you treat it?" John asked, not caring about any other details right now. Nothing else mattered except how they were going to make his youngest well.

Dr. Collins sighed. "To treat the infection, Sam is receiving high doses of broad-spectrum antibiotics through his IV as well as immunoglobulin. To treat everything else – "

"Everything else?" John and Dean interrupted together.

Bobby shook his head. "What else is there?"

"Well, for one thing, Sam is now trached, and we're still dealing with the vent. A common clinical observation is that patients wean more rapidly from mechanical ventilation following tracheotomy, but we have to get Sam to that point. Due to the amount of trauma and stress his body has had to endure in a relatively short time span – it's been less than 24 hours since his admittance – we are keeping him heavily sedated and will most likely continue to do so for at least the next few hours."

"And then Sam will wake up?" Dean asked, desperate to interact with his brother.

Dr. Collins shrugged. "Not necessarily. We'll evaluate everything at that time and then we'll determine whether or not to decrease his sedation."

"And once you decrease his sedation, _then_ Sam will wake up?" Dean clarified, because he needed to know. He needed to be there the exact moment Sam opened his eyes; he needed to be the first person his little brother saw.

Dr. Collins smiled softly, having some idea of Dean's thought process and touched by his devotion to his brother. "Yes, after we decrease his sedation, Sam should begin to come around."

"And then you'll remove the vent and the trach?" Dean persisted, knowing Sam would panic, would be instantly upset the second he realized – he remembered – what had happened.

"Hard to say," Dr. Collins answered honestly. "We certainly want Sam off the vent and breathing on his own again as soon as possible, but that will be determined by numerous factors – the amount of edema still present in his throat and airway, his O2 sats, tidal volume, minute volume, blood gas levels..."

Dean sighed but nodded. As much as he wanted his brother awake and breathing on his own, he didn't want to rush the kid. He could wait as long as Sam needed because there was no way any of them could handle another setback.

"You have other concerns, besides the trach?" John asked.

"Yes," Dr. Collins confirmed. "Sam's blood pressure is still extremely low, so we're giving him vasopressors to try to correct the hypotension. I'm also concerned about his urine output. It's also extremely low, and while we're administering vasodilators, we may have to consider hemodialysis in the near future."

"Dialysis?" Jim repeated, wondering when Sam would catch a break.

"It's a possibility," Dr. Collins confirmed. "Sam's liver panels have shown that his liver is recovering, and he's no longer in acute liver failure – which of course is excellent news, very encouraging. And I'm hoping with more time and perhaps a little extra help, he will bounce back from the acute renal failure as well. The OPSI does, however, complicate things and makes his body have to work twice as hard to overcome everything else."

There was silence.

"Will he survive?"

All eyes turned to John.

"Yes," Dean answered instantly, his tone sharp, his expression hard. How dare John ask that; of course Sam would survive. Whether or not their dad realized it, his little brother was a fighter.

Dr. Collins sighed. "To be honest, death can occur within 24 to 48 hours of OPSI onset, and mortality remains high despite aggressive antibiotic therapy and intensive medical care."

"Doesn't matter," Dean insisted, shaking his head. "Sam's gonna kick this OPSI –and whatever else – in the ass. He's gonna make it."

John closed his eyes briefly. He wasn't one to give up – anyone that knew him would testify to him being a stubbron sonuvabitch – but this didn't sound good. Sam was so sick, so medically fragile.

He glanced at Dean, holding his son's gaze.

Then again, as much as it hurt to admit it, no one – not even himself as Sam's father – knew his youngest like Dean. If Dean said Sam was going to fight, was going to pull through and make it...then he believed him.

"Damn right, he will," John agreed, nodding for emphasis as he continued to hold Dean's gaze, fascinated that no matter how many times their anger and pride tore them apart, Sam always brought them back to center, back together.

Dr. Collins smiled softly. He admired these men's confidence in Sam, their obvious love and devotion for the scrawny kid in Room 7b who, by all intents and purposes, should be gone...no longer with them...expired...passed away...dead. And yet, he hung on. With tenacity that should have long since diminished, with strength that should have waned, with determination that should have faded...Sam clung to what was his. And Dr. Collins admired that, too; respected it, even.

He meant what he had said before – Sam was a tough kid. And if any patient was going to beat the odds, was going to prove him and his over 20 years of medical experience wrong, it was going to be Sam.

But he had to follow protocol.

Dr. Collins sighed. "Sam is certainly fighting – no doubt about that – but unfortunately, it's too soon to tell how this will turn out. At this time, the prognosis is still guarded."

Dean glared as John just stared at him, and Dr. Collins wasn't sure which was most unnerving.

Jim cleared his throat. "Well, doctor, you're certainly entitled to your opinion – even if it's wrong – but when Sam gets better, will he have any long-term side effects from any of this?"

Dr. Collins glanced at the Pastor, amazed at how the man could conduct himself so politely and yet still cut to the bone.

"Will he?" Bobby prompted gruffly, annoyed that this doctor just stared at them sometimes.

Dr. Collins blinked and then shifted where he stood. "Every patient is different, but yes. Typically, patients who survive OPSI often have prolonged and complicated recovery periods with serious long-term effects."

"Like what?" John and Dean demanded in unison.

Dr. Collins shrugged. "Well, like I said, every patient is different, but most long-term effects result from whatever complication they dealt with during the OPSI. So, in Sam's case, he might experience long-term effects on his breathing or possibly even long-term effects of renal failure, if that issue doesn't correct itself soon."

John glanced at Dean and then back to the doctor. "When will we know?"

"Not any time soon," Dr. Collins answered. "We're still days away from that conversation. Right now our primary concern is keeping Sam stable..." – _and alive_ – "...so, we'll be closely monitoring his vitals as well as the dosage of TPA, antibiotics, and immunoglobulin. We'll also be monitoring the incision as well as the trach and vent." He looked around the room, making eye contact with each man. "I assure you that we're doing everything we can for Sam."

There was silence as Jim glanced at Bobby, and then they both looked at John and Dean, who were looking at each other.

John nodded at his son – nonverbal reassurance he knew Dean needed, knew Dean would appreciate despite their earlier altercation.

Dean returned the nod, marveling at the mercurial nature of his relationship with his father. One minute he hated the bastard, despised him for his arrogance and stubbornness, for his selfishness and pre-occupation with the hunt.

And the next minute...

Dean sighed.

He didn't know how he felt the next minute – how he felt now – but he did know one thing.

"I want to see Sam," Dean announced.

"So do I," John agreed and saw Jim and Bobby nod as well.

Dr. Collins didn't respond.

Dean narrowed his eyes. "What?"

"Sam is in isolation, which means only one visitor is allowed at a time, and you must wear disposable protective gear each time you enter his room – gown, gloves, mask, and booties over your shoes. We must take strict precautions to keep everything sterile and not introduce new bacteria or viruses, which would, of course, worsen his current infection."

"Whatever's best for Sam," Dean responded, not liking having to suit up like that, but always willing to do anything to help ensure his brother's safety.

Besides, when Sam finally woke up, the kid wouldn't need to see his entire face to know it was Dean; Sam would just know. And they could communicate with just eye contact. They did it all the time.

Dean smiled softly, physically aching in his chest with his desperation to see Sam, to be with his brother and hold the kid's hand until he woke.

Dr. Collins removed the CT printout from the corkboard and the chest film from the x-ray viewer, placing both back in the folder he still held. "So..." he began, sighing as he glanced between John and Dean. "Who's first?"

As if he needed to ask.

Dean snorted and didn't even glance at his father as he stepped forward, giving the doctor – and the other three – the answer.

Dr. Collins nodded, glancing over his shoulder as he followed Dean out the door and into the hall.

_**TBC**_

_**Christmas, 14 inches of snow and ice in one day, power outages, "unavailable" Internet connections, and traveling all conspired to delay the posting of this chapter. But hopefully it was worth the wait. **_

_**Thanks for your continued interest in and support of this story; the amount of reviews and the degree of enthusiasm is truly humbling. Thank you! See you in the New Year...**_


	20. Chapter 20

Sam's room was empty, and for a split second, Dean felt his heart stop with the customary, all-consuming panic that often set in whenever his little brother wasn't where he was supposed to be.

And then he realized.

Dr. Collins hadn't stopped in the doorway when he did; he had kept walking and even now was continuing down the hall.

Confused and still a little panicked, Dean lingered in the doorway, eyes sweeping the room one last time, before he turned to follow the doctor, long strides bringing him even with the physician.

"Where's Sam?"

Dr. Collins glanced at Dean as they turned the corner and then nodded toward the room at the end of the hall. "In isolation," he responded, his tone puzzled. Surely Dean hadn't already forgotten.

"Yeah, I know. But why did you move him?" Dean demanded, annoyed that he was being made to play hide-and-seek.

"Well for one thing..." Dr. Collins began, stopping as he nodded at the glass. "There's a bigger window in this room, not just the small, thin one in the door. Since there's limited contact with our isolation patients, we like to use the rooms on this wing with the large windows. That way the family can see the patient, and the patient can see their family. It usually boosts everyone's morale."

Dean glanced at the sign on the door – "Contact Precautions" – and then at the cart of protective gear against the wall. "Oh yeah." He reached for one of the yellow gowns. "It's a morale booster, all right," he replied dryly, annoyed by the doctor's cheery tone. It was going to take more than a big window to improve his mood. Especially since the blinds on said window were closed, which meant he still couldn't see his brother.

Dr. Collins watched as Dean slipped the gown over his clothes and then stepped toward him to tie it in the back – but stopped when Dean glared at him.

The doctor cleared his throat self-consciously as awkward silence settled between them.

Dean reached behind himself, tying the gown closed and sighed as he then balanced on one leg, stretching the light blue disposable bootie wide enough to cover his boot; then did the same with his other boot. He bent the wired top edge of the white mask over his nose before looping the strings over his ears, securing it before further situating it on his face. He then grabbed a pair of blue gloves from the box on the top tray of the cart, working his fingers into their respective slots as he gave himself a once over – booties, gown, mask, and gloves.

He was set.

Dr. Collins nodded, giving Dean a once over himself. "Remember that for now, only one person is allowed to visit Sam at a time. So if your father wants to see him..."

"He can do so through the big window," Dean finished. "Maybe it'll boost his morale."

Dr. Collins felt a smile play on his lips, knowing he should probably be annoyed by this sarcastic smartass in front of him but feeling amused.

"Maybe," he agreed, knowing better than to meddle in that particular issue. Who got to sit with Sam was between Dean and his father. Period. He sighed. "Do you have any questions before you go in?"

Dean shook his head, already feeling uncomfortable and hot in the protective gear. "No."

Dr. Collins nodded. "Well, if you do, Karen is with him. She'll be in and out, monitoring Sam. And if she can't answer your questions, I can always be paged."

The words had no sooner been said than the blinds opened, revealing Karen, who visibly startled at the sight of them.

Dr. Collins chuckled as relief flashed in the nurse's eyes. "I don't think she was expecting to see us."

Dean agreed but didn't see the humor, especially since Karen had closed the blinds again before he could glimpse Sam. "Why are the blinds closed? What is she doing to him?"

Dr. Collins lifted an eyebrow – surely Dean wasn't accusing her of doing something inappropriate – and opened his mouth to answer when the door opened, once again revealing Karen.

"I'm glad you're here," she stated, her voice muffled by the mask she wore but her concern clear. "I was just about to page you."

"Why?" Dean and Dr. Collins asked in unison.

Karen's gaze flickered between the two of them before resting on the doctor. "Sam's fever has spiked, 105.2." She hesitated, glad they couldn't see her biting her lip under the mask. "And I think it's still climbing."

"Shit," Dean hissed, growling his frustration as he pushed by Karen and entered his brother's dimly lit room, immediately realizing why the blinds were closed on that big window.

Sam was stripped; his gown removed; the single thin sheet folded down to expose the kid's chest and up to expose his legs, barely covering Sam's groin. There was a yellow basin of ice water on the bedside table, a white washcloth draped over its side and dripping onto the table's surface.

Dean glanced above Sam's bed, gaze tracking the various IV lines to their respective origins, bags filled with solutions to battle three of his brother's biggest enemies right now: infection, blood loss, and dehydration. Other lines and wires led to other equipment. The arterial line inserted into Sam's wrist connected to its own monitor; the small, round electrodes on the kid's chest connected to the cardiac monitor; and the pulse oximeter also connected to a monitor.

Dean approached the bed, eyes scanning his little brother. Sam's legs looked slightly swollen, and a quick glance at the catheter drainage bag confirmed what he already knew – Sam's urine output was still too low. Under the sheet, Dean could see the edges of the bandage that had been placed over the insertion site of the Greenfield filter. The incision on Sam's left side looked marginally better, but inflammation continued to peek out from beneath the white gauze dressing as Dean gently pressed it back in place. And then there was the clear tracheostomy tube protruding from his brother's neck that was connected to yet another tube – blue and ridged – that connected to the ventilator.

"Ah, Sammy..." Dean sighed, sitting on the edge of Sam's bed. He dunked the washcloth into the water, twisting out the excess, and then gently cupped his brother's cheek with the cool fabric. "You gotta fight this, kiddo." He cupped Sam's other cheek. "No way you're being taken out by a fever." He swiped the cloth under damp bangs. "You hear me?"

There was no indication that Sam was listening or was even on the verge of waking. No fluttering eyelids, no twitching fingers, no classic face scrunch. Nothing but a blank – and strangely peaceful – expression, marred only by the hectic crimson patches of rising fever on his cheeks and the mauve bruises of prolonged illness and exhaustion smudged beneath his eyes.

Dean slipped his hand under his brother's neck and held it there; feeling Sam's damp hair and skin along with the sweat-soaked pillowcase; feeling the lingering coolness of the fabric absorbed by the heat.

He sighed again, returning the washcloth to the basin and swirling it among the melting ice. "You gotta get better, Sam," he murmured, moving the freshly cooled cloth over his brother's bony shoulders and down his narrow chest. "Kick this infection in its ass, huh?" He dunked the rag into the water again and then moved back to Sam, rubbing the fabric up and down the kid's thin arms, carefully navigating the IV lines as he did so.

"I was coming back to do that," Karen commented quietly as she came to stand on the opposite side of Sam's bed.

Dean glanced at her but said nothing, annoyed both by her presence – this was a tender moment between just him and his little brother – and that she had implied this – taking care of Sam, tending to Sam – was anyone's job other than his.

Dean sighed harshly, the volume and force indicating his level of annoyance, as he plunged the washcloth into the ice water and once again wiped Sam's flushed cheeks.

Karen stared at Dean's bowed head as he continued his gentle ministrations, sensing she had unintentionally caused an affront with her words and knowing he still was pissed about what had happened earlier. "I'm sorry," she blurted, eager to make amends, desperately wanting to resume their comfortable working relationship.

Dean paused, holding the rag against Sam's forehead as he turned to look at her, his eyes unreadable.

Karen swallowed, wishing she could see the rest of his expression and thankful that he couldn't see hers. "I screwed up earlier. I know that. I wasn't paying as close attention as I should have, and Sam suffered. And I know you're upset about that. I don't blame you. But all I can say is that I'm sorry."

There was a beat of silence before Dean sighed. "I know."

Karen blinked, surprised he was accepting her apology so easily. "You do?"

"Yeah." Dean nodded. "I just tend to hold grudges when it comes to Sam." He glanced at his brother and smiled softly, even though no one could see. "Drives him crazy."

And it was true. Sam bitched incessantly about Dean's unyieldingly overprotective tendencies, but as the adage went, old habits died hard – or in the case of this particular big brother characteristic, not at all. Sam was his – the only thing he valued in this shitty world – and Dean would protect him even when his little brother was old and gray.

Karen smiled, feeling the mask stretch across her face. "So, you forgive me?"

Dean snorted. "Yeah, I guess...but only 'cause Sam would want me to." He removed the washcloth from his brother's forehead and dropped it into the basin on the table. "He believes everybody deserves a second chance, so..." He shrugged as he wrung out the excess water and started again on Sam's shoulders and chest.

"Thank you," Karen responded, her tone relaying the depth of her gratitude and relief. "I promise what happened before won't happen again."

Dean cut his eyes at her. "It better not."

Karen swallowed, wondering how an 18-year old kid could be so...scary. She had no delusions about what would occur if she screwed up again. "It won't," she assured, shaking her head.

Dean held her gaze, nodding once, before returning the washcloth to the basin, soaking up the cold water and then slipping the rag behind Sam's neck, once again holding it there. He could feel the heat consuming his little brother from the inside, burning through any reserves Sam had to fight the infection that raged through his body.

Dean shifted from where he continued to sit on Sam's bed, the mattress dipping under his weight; one leg bent, his gown-covered knee snug against Sam's bare leg, while his other leg stretched downward, boot-clad, bootie-covered foot touching the floor.

"I don't like this," he stated bluntly, glancing at the monitor that recorded Sam's core body temperature from the bladder thermistor catheter. "I think Sam's beyond the benefit of cool compresses."

Karen frowned at the temperature reading – 105.1 – and nodded. "I think you're right. Dr. Collins gave orders for a cooling blanket, if Sam's temperature didn't decrease to at least 103.9 within the next ten minutes, but do you want to go ahead and – "

"Yes," Dean answered, already standing and pushing the bedside table against the wall. "Get it."

Karen nodded, crossing to the far wall and moving yet another machine toward Sam's bed before turning and pulling an extra sheet from one of the cabinets and what looked like a cross between a clear shower curtain and a floor mat used under rolling desk chairs.

Dean narrowed his eyes. "What the hell is that?"

Karen smiled. "The cooling blanket." She paused and nodded toward her patient. "We're going to need to slide this under him. Just be mindful of the trach..."

Dean nodded in response and gently rolled Sam toward him, holding his brother on his side as Karen covered the cooling blanket with the extra sheet and then maneuvered both halfway underneath Sam.

"Okay..." Karen pulled down the cuff of her right glove. "Let's switch sides."

They did so wordlessly and repeated the process, ending up with Sam lying on top of the sheet-covered cooling blanket.

Karen glanced at the monitors, pleased that everything remained stable, and began hooking up the various lines and tubes than ran from the machine to the blanket. "You'd make a good nurse," she commented, hoping Dean could see the smile in her eyes.

Dean snorted, brushing back the bangs that had fallen across Sam's eyes during all the shifting and movement. "Yeah."

"The hospital's hiring," Karen informed, enjoying the banter as she adjusted the temperature control setting on the machine.

"Nah." Dean continued to stare at his brother. "I already got a job."

Karen felt that familiar flutter in her chest as she glanced up, wondering if she'd ever tire of witnessing these touching moments between the brothers. "Yeah," she agreed quietly. "And you're pretty good at it, too."

Dean raised his eyes to hers and held her gaze for a few seconds. "You're not too bad at yours, either."

Karen felt tears sting her eyes. She had been told numerous times by numerous patients that she was a good nurse – and she believed it, knew it to be true – but nothing compared to hearing Dean tell her in his own unique way, especially after everything they had been through over the past few hours. "Thanks," she whispered.

Dean shrugged – moment over – and returned his attention back to Sam, once again perching on the side of his bed, careful not to sit on the cooling blanket.

Karen sighed. "We should start seeing a change in Sam's temperature in the next ten to twenty minutes." She glanced at the clock. "I have another patient down the hall that I need to check on, but I'll be back," she promised as she gave one final check to the cooling blanket and its machine as well as to the other monitors before crossing to the door and exiting into the hall.

Dean nodded and settled in for his vigil.

Almost two hours passed.

Karen came and went several times, reporting that his dad and the others had arrived outside Sam's room.

But Dean continued to sit on Sam's bed.

After another hour passed, Dean realized he was hot and uncomfortable, his clothes actually damp from the sweat-inducing yellow polyester gown that covered them. His hands were slick inside the gloves; he could feel beads of sweat under the mask and knew that he would have a red indentation across his nose and cheeks when he finally removed it. His back hurt; his butt and legs were numb; and his neck and shoulders ached from holding one position so long. But he continued to sit there beside his little brother, small hand protectively enveloped by his larger one.

Dean sighed, glancing at the infamous big window. Although Sam's fever had dropped to a manageable level – thank you, drugs and cooling blanket – and he was once again wearing a gown and covered with a light sheet, the blinds on the window remained closed. Even so, Dean could still see the silhouette of his father pacing in the hall and wondered idly where Bobby and Jim were that he couldn't see their profiles as well.

It would suck to be in the hall, and Dean wasn't looking forward to his turn, wasn't sure when he would give up his spot beside Sam.

He was certainly in no rush.

Karen had decreased Sam's sedation twenty minutes ago, and there was no way Dean would even consider leaving until he saw Sam's eyes open.

Dean knew John, Jim, and Bobby were getting updates from Karen and Dr. Collins, so they were not in the dark about all that had transpired over the past few hours. He knew – even without Karen's not-so-subtle comments – that John wanted to see Sam, wanted to see for himself that his youngest was indeed okay for now.

But Dean just couldn't leave his brother.

The fever crisis may have passed hours ago but not the danger. Sam was alarmingly weak, and if Dean was honest with himself, he was frightened by his little brother's fragility. Sam was a tough kid, but even a tough kid could only take so much, and his strength was inexorably fading.

Dean sighed again as he gently stroked Sam's hair, allowing his hand to lightly trail down his brother's temple, along his jaw until he was cupping the kid's cheek, feeling a faint thread of pulse move beneath his fingers. Sam's skin was still too warm, his face too pale beneath the fading flush of fever.

"You gotta get better, Sam," Dean murmured, having lost track of how many times he had said that over the past few hours. But there was nothing else to say. "You hear me?" Dean lightly squeezed his brother's hand. "You gotta get better."

There was a soft flutter of motion beneath the sheet as consciousness communicated itself through the thick fog of medication and bone-weary fatigue.

Dean held his breath, releasing it on one word. "Sammy..."

Sam shifted again, and Dean watched as faint cognition slowly surfaced through the deep well of darkness that harnessed his brother to the bed, imprisoning him in the numb existence the sedation had imposed on him for so long.

Sam's fingers twitched in Dean's hand, and he moved his head weakly, struggling to free himself from the fierce hold of the medications. In the next instant, Sam's face scrunched, and Dean chuckled softly.

It wouldn't be long now.

"C'mon, Sammy..." Dean spoke softly, continuing to stroke the kid's damp hair. He didn't want to rush his brother, to yank him mercilessly from the cocoon of dulled pain into the unkind reality of the hospital room.

Pale eyelids fluttered open, a thick glaze coating the hazel eyes; the pupils dilated widely from the cocktail of pain medications, masking the rim of color on the iris.

For a moment, Sam stared blindly up at his brother, trying to orient himself, overwhelmed by sensations.

Dean waited patiently, knowing that Sam's vision was blurred and that all of his brother's focus would be internal, taking a mental inventory of his body, of what still hurt.

Sam winced, wrinkling his nose and blinking his eyes as he shifted minutely on the bed. He stared at the hazy figure above him, only able to see the person's eyes since the rest of the face was covered with a mask.

And yet he knew.

Sam's lips moved to form a word, but there was no sound. _Dean._

"I'm here, Sam," Dean reassured, gently squeezing his brother's hand. "Right here, kiddo."

A ghost of a smile flickered on Sam's lips as his eyes dipped closed. He knew it. Dean was there. And that was all he ever needed to hear.

Sam attempted to turn his head more toward Dean but stopped when he felt resistance, felt a tug in the center of his neck.

Dean felt himself tense during the beat of hesitation – Sam was trying to figure out what he felt – and wasn't surprised when his brother's eyes snapped open in realization at the same instant his left hand was reaching for the trach tube.

"Whoa. Hey...stop," Dean ordered, grasping the kid's hand and holding it. "Leave it alone. I know you're freaked out, but you need it to breathe right now, okay?"

For a moment, panic flashed in Sam's eyes, and then they closed suddenly. His respiration quickened as a phantom of pain crossed his bleached face. Something like a sob tore from his throat as his fingers clenched Dean's hand.

Dean held his breath, stealing himself against the assault of Sam's pain and confusion. "It's okay, Sammy," he soothed, squeezing his brother's hand before placing it back by his side on the mattress and gently patting the kid's chest. "You're okay."

Sam's eyes opened as suddenly as they had closed and focused on Dean. Fear shone in his gaze, and Dean knew Sam understood how sick he was, how precarious and desperate their lives had become.

Sam's eyes filled with tears, suspended on the rims, glimmering in the dim light. Then, as if time had released its hold on the moment, the tears spilled freely over the end of his lashes and swept down his cheeks as he squeezed his eyes shut.

A sharp and bitter agony ripped through Dean's heart, tearing away the last vestige of his own control. His eyes misted, filled, but he refused to allow Sam to see his pain. He thumbed the tears from his little brother's cheeks and leaned forward, arching his back to avoid the trach, and pressed his forehead to Sam's as he tightened his grip on the kid's hand.

"I know, Sam," Dean whispered and then swallowed, almost choking over the lump of emotion that rested in his throat, the tightness making his voice hoarse. He sighed. "I know..."

They stayed that way – forehead against forehead – for several minutes until Sam slowly opened his eyes, staring straight into Dean's unwavering gaze.

Dean lifted his head, easing back so he could see his brother better, and then rested his hand on Sam's forehead before sliding it down to cup his cheek. Sam leaned into his touch, and Dean smiled affectionately, wondering how it was possible to love one person so much.

"You remember our deal?"

Sam's head bobbed in Dean's grasp.

Dean's thumb brushed away the remaining moisture on Sam's cheek. "You still gonna hold up your end?"

Sam nodded again, weakness making the movement barely perceptible.

"That's my boy," Dean responded automatically and smiled when Sam leaned even deeper into his touch, blinking drowsily up at him. He nodded. "It's okay, Sammy. Go back to sleep."

Sam seemed to understand but continued to fight the lingering effects of sedation until his eyes slowly closed. But the hand in Dean's held fast, communicating a need all its own.

Dean gently lifted his little brother's hand and held it to his own chest, releasing a shuddering breath as he closed his eyes. He did not consider himself to be religious, to believe in anything he couldn't see. But the adage was true – desperate times called for desperate measures, and in his heart he prayed one word.

_Please..._

_**TBC**_

_**Since it's been over two weeks since I've updated this story, I guess you've figured out that the posting schedule I once adhered to has completely gone out the window. My apologies. As always, thanks for reading and reviewing. Hope 2011 is treating you well thus far!**_


End file.
